Predictors of endoscopic treatment outcomes in the management of biliary problems after liver transplantation at a high-volume academic center

Buxbaum, James; Biggins, Scott W.; Bagatelos, Karen C.; Ostroff, James W.

doi:10.1016/j.gie.2010.09.007

Cited by 42 publications

(50 citation statements)

References 28 publications

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“…The majority of centers use ERC plus ballon dilatation with (40) or without (9) stent placement for the treatment of AS. In case of very early stenosis (<4 weeks after LT), dilatation can provoke anastomotic leakage and might therefore be postponed.…”

Section: Therapy Of Anastomotic Stenosismentioning

confidence: 99%

“…Also after LDLT balloon dilatation plus single or multiple stenting has been reported with good success rates (51). However, partial LT and DCD remain negative prognostic factors (40). Although the overall success rate of AS therapy is very high (98%) a close follow-up is indicated, since the risk of recurrence is relevant.…”

Section: Therapy Of Anastomotic Stenosismentioning

confidence: 99%

“…In severe cases with biliary necrosis and casts, repeated interventions with baskets and dilatations are necessary (40). Placement of stents is not generally recommended in the early course, since they tend to be occluded by biliary debris.…”

Section: Therapy Of Nasmentioning

confidence: 99%

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Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

258

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Section: Therapy Of Anastomotic Stenosismentioning

confidence: 99%

Section: Therapy Of Anastomotic Stenosismentioning

confidence: 99%

See 1 more Smart Citation

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

258

233

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“…There is general agreement that non-BASs are intractable to endoscopic management [10,18]. Endoscopic therapy may be more likely to fail in LDLT patients with a history of hepatic artery stenosis [10] and surgery for bleeding during the first month after liver transplantation [107], which are potentially related to ischemia, leading to non-BAS formation. Morphological changes in the biliary tree as well as stricture are strongly associated with the outcome of endoscopic intervention [28,67,108,109].…”

Section: Risk Factors or Failed Endoscopic Management Of Post-ldlt Bimentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

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“…The aforementioned risk factors play important roles in the development of anastomotic biliary strictures and may also be influenced by the MELD score. 2,3 In addition, the use of T-tubes may influence bile leaks and the development of biliary strictures. 4 The inclusion of this variable in the final multivariate model may have affected the association of bile leaks and the development of anastomotic biliary strictures.…”

Section: To the Editorsmentioning

confidence: 99%

The model for end-stage liver disease score and posttransplant biliary complications

Balderramo

Cárdenas

2011

Liver Transpl

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TO THE EDITORS:In a recent retrospective analysis, Sundaram et al. 1 used a prospectively collected database of 1798 recipients of deceased donor livers from the eras before and after the implementation of the Model for End-Stage Liver Disease (MELD) to evaluate the effects of the MELD score on the development of biliary complications. We believe that these data are important and highlight some of the limitations of the MELD score with respect to specific outcomes after liver transplantation.Two issues perhaps could be clarified. After they evaluated more than 20 potential donor, recipient, and technical risk factors, Sundaram et al.1 found that the donor age, bile leaks, duct-to-duct anastomoses, and the MELD era were independent factors for the development of anastomotic biliary strictures. Although some intraoperative and perioperative factors were evaluated, information about the total surgical time, the intraoperative transfusion requirements, and the need for reoperation in the early postoperative period was lacking in the analysis. The aforementioned risk factors play important roles in the development of anastomotic biliary strictures and may also be influenced by the MELD score. 2,3 In addition, the use of T-tubes may influence bile leaks and the development of biliary strictures. 4 The inclusion of this variable in the final multivariate model may have affected the association of bile leaks and the development of anastomotic biliary strictures.The other issue is the fact that virtually all bile leaks (97%) were found before the diagnosis of an anastomotic stricture (82 patients in the control group and 22 patients in the stricture group). These findings are puzzling because a significant number of the bile leaks (nearly half) were diagnosed 3 months after liver transplantation. It would be interesting to know more about the nature of these leaks because the majority of bile leaks appear within the first 3 months after liver transplantation in clinical practice.

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Predictors of endoscopic treatment outcomes in the management of biliary problems after liver transplantation at a high-volume academic center

Cited by 42 publications

References 28 publications

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Endoscopic management of biliary strictures after living donor liver transplantation

The model for end-stage liver disease score and posttransplant biliary complications

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