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• W2127492798 abstract "BackgroundLiving-donor liver transplantation (LDLT) has emerged as a viable strategy in an era of extreme organ shortage. However, biliary strictures remain the Achilles' heel of LDLT. The optimal endoscopic treatment for anastomotic biliary strictures (ABS) after LDLT is undefined.AimTo determine the outcome of an aggressive endoscopic approach that uses endoscopic dilatation followed by maximal stent placement at a single tertiary–care academic medical center.MethodsWe retrospectively reviewed our transplant database for all LDLT performed between March 2001 and September 2010. Demographic data was collected and treatment outcomes, including bile-duct patency, recurrence of stricture, need for surgical intervention, morbidity, and mortality were evaluated.ResultsOf 106 LDLTs completed at our institution since 2001, 41 (38.7%) developed a biliary stricture after transplant; 38 patients had duct to duct anastomoses and are included in the analysis. The mean follow-up time is 54 months (range 2.5–97 months). Among them, 23 (60.5%) were male, 20 (52.6%) had bile leakage, and 6 required concomitant percutaneous transhepatic cholangiodrainage. The mean time to the development ABS after LDLT was 4 months. The mean time to stricture resolution was 6.6 months. The strictures took an average of 4.3 interventions and 7.9 stents to resolve. There was statistically significant improvement in biochemical markers after intervention, including aspartate transaminase (76 vs 39, P = .001), alanine transaminase (127.5 vs 45.5, P < .001), alkaline phosphatase (590 vs 260, P < .001) and total bilirubin (2.57 vs 1.73, P = .017). Eight patients (21%) had recurrent stricture after initial treatment. All recurrences were treated successfully endoscopically. All patients have been managed without surgical revision or re-transplantation, resulting in 100% success by an intention-to-treat analysis.ConclusionsIn our experience, aggressive endoscopy-based treatment with maximal stent placement strategy allows 100% resolution of all ABS after LDLT without the need for surgical intervention or re-transplantation. BackgroundLiving-donor liver transplantation (LDLT) has emerged as a viable strategy in an era of extreme organ shortage. However, biliary strictures remain the Achilles' heel of LDLT. The optimal endoscopic treatment for anastomotic biliary strictures (ABS) after LDLT is undefined. Living-donor liver transplantation (LDLT) has emerged as a viable strategy in an era of extreme organ shortage. However, biliary strictures remain the Achilles' heel of LDLT. The optimal endoscopic treatment for anastomotic biliary strictures (ABS) after LDLT is undefined. AimTo determine the outcome of an aggressive endoscopic approach that uses endoscopic dilatation followed by maximal stent placement at a single tertiary–care academic medical center. To determine the outcome of an aggressive endoscopic approach that uses endoscopic dilatation followed by maximal stent placement at a single tertiary–care academic medical center. MethodsWe retrospectively reviewed our transplant database for all LDLT performed between March 2001 and September 2010. Demographic data was collected and treatment outcomes, including bile-duct patency, recurrence of stricture, need for surgical intervention, morbidity, and mortality were evaluated. We retrospectively reviewed our transplant database for all LDLT performed between March 2001 and September 2010. Demographic data was collected and treatment outcomes, including bile-duct patency, recurrence of stricture, need for surgical intervention, morbidity, and mortality were evaluated. ResultsOf 106 LDLTs completed at our institution since 2001, 41 (38.7%) developed a biliary stricture after transplant; 38 patients had duct to duct anastomoses and are included in the analysis. The mean follow-up time is 54 months (range 2.5–97 months). Among them, 23 (60.5%) were male, 20 (52.6%) had bile leakage, and 6 required concomitant percutaneous transhepatic cholangiodrainage. The mean time to the development ABS after LDLT was 4 months. The mean time to stricture resolution was 6.6 months. The strictures took an average of 4.3 interventions and 7.9 stents to resolve. There was statistically significant improvement in biochemical markers after intervention, including aspartate transaminase (76 vs 39, P = .001), alanine transaminase (127.5 vs 45.5, P < .001), alkaline phosphatase (590 vs 260, P < .001) and total bilirubin (2.57 vs 1.73, P = .017). Eight patients (21%) had recurrent stricture after initial treatment. All recurrences were treated successfully endoscopically. All patients have been managed without surgical revision or re-transplantation, resulting in 100% success by an intention-to-treat analysis. Of 106 LDLTs completed at our institution since 2001, 41 (38.7%) developed a biliary stricture after transplant; 38 patients had duct to duct anastomoses and are included in the analysis. The mean follow-up time is 54 months (range 2.5–97 months). Among them, 23 (60.5%) were male, 20 (52.6%) had bile leakage, and 6 required concomitant percutaneous transhepatic cholangiodrainage. The mean time to the development ABS after LDLT was 4 months. The mean time to stricture resolution was 6.6 months. The strictures took an average of 4.3 interventions and 7.9 stents to resolve. There was statistically significant improvement in biochemical markers after intervention, including aspartate transaminase (76 vs 39, P = .001), alanine transaminase (127.5 vs 45.5, P < .001), alkaline phosphatase (590 vs 260, P < .001) and total bilirubin (2.57 vs 1.73, P = .017). Eight patients (21%) had recurrent stricture after initial treatment. All recurrences were treated successfully endoscopically. All patients have been managed without surgical revision or re-transplantation, resulting in 100% success by an intention-to-treat analysis. ConclusionsIn our experience, aggressive endoscopy-based treatment with maximal stent placement strategy allows 100% resolution of all ABS after LDLT without the need for surgical intervention or re-transplantation. In our experience, aggressive endoscopy-based treatment with maximal stent placement strategy allows 100% resolution of all ABS after LDLT without the need for surgical intervention or re-transplantation." @default.
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• W2127492798 date "2011-02-01" @default.
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• W2127492798 title "Endoscopic Treatment of Anastomotic Biliary Strictures After Living Donor Liver Transplantation: Outcomes After Maximal Stent Therapy" @default.
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