Long-term outcomes of endoscopic treatment for duct-to-duct anastomotic strictures after living donor liver transplantation.
Anastomosis, Surgical
Cholangiopancreatography, Endoscopic Retrograde
Cholestasis
/ surgery
Constriction, Pathologic
/ surgery
Endoscopy, Digestive System
/ methods
Female
Humans
Liver Transplantation
/ adverse effects
Living Donors
Logistic Models
Male
Middle Aged
Postoperative Complications
/ surgery
Recurrence
Retrospective Studies
Stents
Treatment Outcome
benign biliary stricture
bile duct kinking
endoscopic retrograde cholangiopancreatography
inside stent
predictive factors
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
25
03
2019
revised:
14
08
2019
accepted:
16
08
2019
pubmed:
23
8
2019
medline:
22
9
2020
entrez:
23
8
2019
Statut:
ppublish
Résumé
The anastomotic biliary stricture is a clinically important complication after living donor liver transplantation (LDLT) with a duct-to-duct anastomosis. Although endoscopic management of post-LDLT biliary strictures using balloon dilation (BD) and plastic stents (PSs) has provided acceptable short-term outcomes, long-term outcomes and prognostic factors for treatment success remain unclear. We included 96 patients with post-LDLT biliary strictures who were endoscopically managed between 2003 and 2016. BD was utilized as a first-line treatment strategy, and PS placement was carried out for refractory cases. Potential prognostic factors for biliary stricture resolution were analysed using logistic regression analyses. Endoscopic treatment was technically successful in 84 patients (87.5%). The overall rate of biliary stricture resolution was 44.8% (43 of 96 patients) with a median follow-up duration of 90.9 months (interquartile range, 30.9-122.3 months). Bile duct kinking was associated with a lower rate of biliary stricture resolution (odds ratio, 0.33; 95% confidence interval, 0.13-0.87). After successful endoscopic treatment, biliary strictures recurred in 22 patients (57.9%) after BD, and in one patient (4%) after PS treatment. Despite a high technical success rate, endoscopic treatment only provided a low rate of resolution of anastomotic biliary strictures among LDLT patients and required prolonged treatment duration. Alternative strategies including the use of a covered metal stent should be evaluated to further improve the treatment outcomes of post-LDLT biliary strictures, particularly in those accompanied by the bile duct kinking.
Sections du résumé
BACKGROUND AND AIMS
The anastomotic biliary stricture is a clinically important complication after living donor liver transplantation (LDLT) with a duct-to-duct anastomosis. Although endoscopic management of post-LDLT biliary strictures using balloon dilation (BD) and plastic stents (PSs) has provided acceptable short-term outcomes, long-term outcomes and prognostic factors for treatment success remain unclear.
METHODS
We included 96 patients with post-LDLT biliary strictures who were endoscopically managed between 2003 and 2016. BD was utilized as a first-line treatment strategy, and PS placement was carried out for refractory cases. Potential prognostic factors for biliary stricture resolution were analysed using logistic regression analyses.
RESULTS
Endoscopic treatment was technically successful in 84 patients (87.5%). The overall rate of biliary stricture resolution was 44.8% (43 of 96 patients) with a median follow-up duration of 90.9 months (interquartile range, 30.9-122.3 months). Bile duct kinking was associated with a lower rate of biliary stricture resolution (odds ratio, 0.33; 95% confidence interval, 0.13-0.87). After successful endoscopic treatment, biliary strictures recurred in 22 patients (57.9%) after BD, and in one patient (4%) after PS treatment.
CONCLUSIONS
Despite a high technical success rate, endoscopic treatment only provided a low rate of resolution of anastomotic biliary strictures among LDLT patients and required prolonged treatment duration. Alternative strategies including the use of a covered metal stent should be evaluated to further improve the treatment outcomes of post-LDLT biliary strictures, particularly in those accompanied by the bile duct kinking.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1954-1963Informations de copyright
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Jain A, Reyes J, Kashyap R, et al. Long-term survival after liver transplantation in 4,000 consecutive patients at a single center. Ann Surg. 2000;232(4):490-500.
Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. The New England Journal of Medicine. 1996;334(11):693-699.
Mazzaferro V, Bhoori S, Sposito C, et al. Milan criteria in liver transplantation for hepatocellular carcinoma: an evidence-based analysis of 15 years of experience. Liver Transpl. 2011;17(Suppl 2):S44-57.
Trotter JF, Wachs M, Everson GT, Kam I. Adult-to-adult transplantation of the right hepatic lobe from a living donor. N Engl J Med. 2002;346(14):1074-1082.
Sugawara Y, Makuuchi M. Advances in adult living donor liver transplantation: a review based on reports from the 10th anniversary of the adult-to-adult living donor liver transplantation meeting in Tokyo. Liver Transpl. 2004;10(6):715-720.
Chan SC, Cheung TT, Chan A, et al. New insights after the first 1000 liver transplantations at The University of Hong Kong. Asian J Surg. 2016;39(4):202-210.
Akamatsu N, Sugawara Y, Hashimoto D. Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: a systematic review of the incidence, risk factors and outcome. Transpl Int. 2011;24(4):379-392.
Verdonk RC, Buis CI, Porte RJ, et al. Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl. 2006;12(5):726-735.
Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl. 2008;14(6):759-769.
Zimmerman MA, Baker T, Goodrich NP, et al. Development, management, and resolution of biliary complications after living and deceased donor liver transplantation: a report from the adult-to-adult living donor liver transplantation cohort study consortium. Liver Transpl. 2013;19(3):259-267.
Chang JH, Lee IS, Choi JY, et al. Biliary stricture after adult right-lobe living-donor liver transplantation with duct-to-duct anastomosis: long-term outcome and its related factors after endoscopic treatment. Gut and Liver. 2010;4(2):226-233.
Sugawara Y, Sano K, Kaneko J, et al. Duct-to-duct biliary reconstruction for living donor liver transplantation: experience of 92 cases. Transplant Proc. 2003;35(8):2981-2982.
Ishiko T, Egawa H, Kasahara M, et al. Duct-to-duct biliary reconstruction in living donor liver transplantation utilizing right lobe graft. Ann Surg. 2002;236(2):235-240.
Alazmi W, Fogel E, Watkins J, et al. Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation. Endoscopy. 2006;38(6):571-574.
Holt AP, Thorburn D, Mirza D, Gunson B, Wong T, Haydon G. A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation. Transplantation. 2007;84(7):857-863.
Tabibian JH, Asham EH, Han S, et al. Endoscopic treatment of postorthotopic liver transplantation anastomotic biliary strictures with maximal stent therapy (with video). Gastrointest Endosc. 2010;71(3):505-512.
Tsujino T, Isayama H, Sugawara Y, et al. Endoscopic management of biliary complications after adult living donor liver transplantation. Am J Gastroenterol. 2006;101(10):2230-2236.
Yazumi S, Yoshimoto T, Hisatsune H, et al. Endoscopic treatment of biliary complications after right-lobe living-donor liver transplantation with duct-to-duct biliary anastomosis. J Hepatobiliary Pancreat Surg. 2006;13(6):502-510.
Kim TH, Lee SK, Han JH, et al. The role of endoscopic retrograde cholangiography for biliary stricture after adult living donor liver transplantation: technical aspect and outcome. Scand J Gastroenterol. 2011;46(2):188-196.
Hsieh T-H, Mekeel KL, Crowell MD, et al. Endoscopic treatment of anastomotic biliary strictures after living donor liver transplantation: outcomes after maximal stent therapy. Gastrointest Endosc. 2013;77(1):47-54.
Kurita A, Kodama Y, Minami R, et al. Endoscopic stent placement above the intact sphincter of Oddi for biliary strictures after living donor liver transplantation. J Gastroenterol. 2013;48(9):1097-1104.
Urata K, Kawasaki S, Matsunami H, et al. Calculation of child and adult standard liver volume for liver transplantation. Hepatology. 1995;21(5):1317-1321.
Kokudo N, Sugawara Y, Imamura H, Sano K, Makuuchi M. Tailoring the type of donor hepatectomy for adult living donor liver transplantation. Am J Transplant. 2005;5(7):1694-1703.
Sugawara Y, Makuuchi M, Kaneko J, et al. Living-donor liver transplantation in adults: Tokyo University experience. Journal of Hepato-Biliary-Pancreatic Surgery. 2003;10(1):1-4.
Sugawara Y, Makuuchi M, Kaneko J, Ohkubo T, Imamura H, Kawarasaki H. Correlation between optimal tacrolimus doses and the graft weight in living donor liver transplantation. Clin Transplant. 2002;16(2):102-106.
Pfitzmann R, Klupp J, Langrehr JM, et al. Mycophenolatemofetil for immunosuppression after liver transplantation: a follow-up study of 191 patients. Transplantation. 2003;76(1):130-136.
Akamatsu N, Sugawara Y, Tamura S, Matsui Y, Kaneko J, Makuuchi M. Efficacy of mycofenolate mofetil for steroid-resistant acute rejection after living donor liver transplantation. World J Gastroenterol. 2006;12(30):4870-4872.
Isayama H, Hamada T, Yasuda I, et al. TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc. 2015;27(2):259-264.
Macias-Gomez C, Dumonceau JM. Endoscopic management of biliary complications after liver transplantation: an evidence-based review. World J Gastrointest Endosc. 2015;7(6):606-616.
Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71(3):446-454.
Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013;48(3):452-458.
Tsujino T, Isayama H, Kogure H, Sato T, Nakai Y, Koike K. Endoscopic management of biliary strictures after living donor liver transplantation. Clin J Gastroenterol. 2017;10:297-311.
Zoepf T, Maldonado-Lopez EJ, Hilgard P, et al. Balloon dilatation vs. balloon dilatation plus bile duct endoprostheses for treatment of anastomotic biliary strictures after liver transplantation. Liver Transpl. 2006;12(1):88-94.
Zheng X, Wu J, Sun BO, et al. Clinical outcome of endoscopic covered metal stenting for resolution of benign biliary stricture: systematic review and meta-analysis. Dig Endosc. 2017;29(2):198-210.
Zhang X, Wang X, Wang L, Tang R, Dong J. Effect of covered self-expanding metal stents compared with multiple plastic stents on benign biliary stricture: a meta-analysis. Medicine (Baltimore). 2018;97(36):e12039.
Tal AO, Finkelmeier F, Filmann N, et al. Multiple plastic stents versus covered metal stent for treatment of anastomotic biliary strictures after liver transplantation: a prospective, randomized, multicenter trial. Gastrointest Endosc. 2017;86(6):1038-1045.
Martins FP, De Paulo GA, Contini M, Ferrari AP. Metal versus plastic stents for anastomotic biliary strictures after liver transplantation: a randomized controlled trial. Gastrointest Endosc. 2018;87(1):131.e1-131.e13.
Wan P, Xia Q, Zhang JJ, et al. Bile duct kinking after adult living donor liver transplantation: case reports and literature review. J Dig Dis. 2015;16(10):610-615.
Yoshimoto T, Yazumi S, Hisatsune H, Egawa H, Maetani Y, Chiba T. Crane-neck deformity after right lobe living donor liver transplantation. Gastrointest Endosc. 2006;64(2):271.
Pedersen FM, Lassen AT, Schaffalitzky de Muckadell OB. Randomized trial of stent placed above and across the sphincter of Oddi in malignant bile duct obstruction. Gastrointest Endosc. 1998;48(6):574-579.