The effectiveness of non-surgical interventions in biliary duct complications after liver transplantation
F.J.M. Roos, J.W. Poley, B.E. Hansen, A. Moelker, W.G. Polak, H.J. Metselaar
Chair(s): dr. M.A.C.J. Gelens
Thursday 9 march 2017
12:30 - 12:45h
Categories: Poster - Klinisch
Parallel session: Postersessie - Klinisch 4
Biliary duct complications, consisting of bile duct leakage and bile duct strictures, remain the Achilles’ heel of orthotopic liver transplantation (OLT), with a reported incidence of up to 40%. Treatments of first choice are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) with a reported wide range ofeffectiveness of 50 till 100%. We performed a single-center retrospective cohort study to evaluate the success rate of non-surgical interventions in liver transplant recipients with biliary complications. Additionally, we looked for risk factors for failure of this mode of therapy.
Study period was between January 2006 and December 2015. Graft-, recipient- and treatment characteristics were collected. Treatment was defined a success, if radiologic imaging showed resolving of bile duct complication without additional intervention in six months thereafter. A multivariate analysis was performed to identify risk factors for failure of therapy.
Overall 451 transplants were included in this study. Biliary duct complications developed in 35.5 percent of liver grafts (n=160). Anastomotic bile duct stricture (AS) was the most common complication (n=100), followed by non-anastomotic bile duct strictures (NAS) (n=39) and bile duct leakage (n=14). ERCP was the primary choice of treatment in 115 cases and PTC in 34. Overall success rate was 80%. AS could be successfully treated with non-surgical interventions in 84%, bile duct leakage in 88% and NAS in 45% of the cases, respectively. No differences between ERCP and PTC were observed in relapse rate of bile duct complication, treatment related complications and duration of treatment. Prolonged warm ischemia time (WIT) in minutes (HR. 1.06, 95%CI 1.02-1.10; p<0.01) and diagnosis of NAS (HR. 1.92, 95%CI 1.24-2.96; p<0.001) were associated with failure of treatment.
Conclusion: Biliary duct complications after OLT are common. Non-surgical interventions, independently of type of procedure, are successful for management of AS and bile duct leakage. NAS and prolonged  WIT are associated with less successful therapy outcome.
