Anastomotic bilio-biliary stricture after adult liver transplantation: A retrospective study over 20 years in a single center.

Abstract

BACKGROUND:

Biliary complications are the main surgical complication after liver transplantation (LT). The aims of the present retrospective single center study were to describe anastomotic bilio-biliary strictures (ABS) in a large cohort of liver transplant recipients with long follow-up.

METHODS:

All adult LT recipients who underwent a LT, with bilio-biliary anastomosis, between 1990 and 2010 in Edouard Herriot hospital, Lyon, France were included in the study.

RESULTS:

The study population consisted in 783 patients (70.0% males), median age 50.5 years; main indication was alcohol-related liver disease (46.8%). The median follow-up after LT was 11.9 years (range 0-27 years). The overall incidence of anastomotic biliary complications was 9.7%: 50 patients developed an ABS (6.6%), after a median delay of 4.4 months (range 0.1-245.2) after LT and 32 (4.1%) developed biliary leakage after a median delay of 25 days (range 1-179). The actuarial risk of developing an ABS was 1.6% at 1-month, 2.7% at 3-months, 4.1% at 6-months, and 5.1%, 6.0%, 6.4%, 6.6%, 7.3% at 1-, 2-, 5-, 10- and 15-years, respectively. Univariate analysis disclosed that post-reperfusion syndrome and liver graft steatosis (≥30%) were significant risk factors for ABS. Multivariate analysis disclosed that graft steatosis (OR=6.262, 95%CI 1.936-20.257, P=0.002) and MELD score (OR=1.071, 95%CI 1.018-1.128, P=0.008) were significant risk factors for ABS. The first-line treatment of ABS consisted in endoscopic stenting for 44 patients (88.0%) and immediate success rate was 75.0%. Delayed recurrence of ABS occurred in 8/33 patients (24.0%).

CONCLUSION:

Our results suggest that steatotic grafts should be used for recipients without severe liver failure to avoid ABS, and that endoscopic stenting of post-LT ABS leads to a high success rate, but is associated with a significant risk of recurrence.

• Authors: Jérôme Dumortier, Christine Chambon-Augoyard, Olivier Guillaud, Mathieu Pioche, Jérôme Rivory, Pierre-Jean Valette, Mustapha Adham, Thierry Ponchon, Jean-Yves Scoazec, Olivier Boillot
• Journal: Clinics and research in hepatology and gastroenterology (Clin Res Hepatol Gastroenterol) Vol. 44 Issue 4 Pg. 564-571 (09 2020) ISSN: 2210-741X [Electronic] France
• PMID: 31547998 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Masson SAS. All rights reserved.

Topics

• Anastomosis, Surgical
• Biliary Tract Surgical Procedures
• Constriction, Pathologic (surgery)
• Female
• Humans
• Liver Transplantation
• Male
• Middle Aged
• Postoperative Complications (surgery)
• Retrospective Studies
• Time Factors