Management of Post-transplant Biliary Stricture after Living Donor Liver Transplant in Adult Recipients. | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 44, Issue 2, April 2025, Page 752-759 PDF (534.18 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2024.335523.1272 | ||||
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| Authors | ||||
Ibrahim Abdel-Kader Salama1; Ahmed Shawki Ali Oteem  1; Taha Eid Yassein1; Mohamed Shawky Alwarraky2; Mai Ibrahim Abozeid3; Eslam Ismail Ayoub1
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| 1Departments of HepatoPancreaticobiliary Surgery, National Liver Institute, Menoufia University, Egypt | ||||
| 2Departments of Diagnostic and Interventional Radiology, National Liver Institute, Menoufia University, Egypt | ||||
| 3Departments of Hepatology, National Liver Institute, Menoufia University, Egypt | ||||
| Abstract | ||||
| Background: Biliary stricture was a common problem after living donor liver transplantation (LDLT), it represents an independent risk factor for post-transplant morbidity and mortality. Objectives: Studying the management options for post-transplant biliary strictures after LDLT for adult recipients and evaluate the outcome of each method of management on morbidity and mortality of such patients. Patients and Methods: This study, which was approved by our institutional review board (IRB), involved 67 adult recipients of LDLT, including 38 who experienced postoperative biliary stricture between January 2015 and the end of October 2023 after the exclusion of the pediatric age group (less than 18 years old). Group A consisted of 29 patients without stricture, whereas group B comprised 38 individuals with stricture. To determine the potential risk factors for the development of biliary stricture, a comparative analysis of many variables was conducted. Results: Out of 67 adult recipients. 38 recipients had suffered postoperative biliary stricture. They were as 32(84.2%) males and six (15.8%) females. The mean onset of biliary stricture was (7.97 months±5.5). Endoscopic management (ERCP) was done in 29 patients and failed in four patients. Percutaneous transhepatic dilatation and stenting was done in 16(42.1%) patients with Randeveau technique (percutaneous transhepatic dilatation and stenting with ERCP) was done in nine (23.6%) patients, 10(26.3%) patients underwent surgery (hepatico-jejunostomy) after failed endoscopic and percutaneous intervention. There was a statistically significant difference regarding multiple bile ducts, increased donor age, increased time of arterial anastomosis, usage of biliary stent increased ischemia time, that considered risk factors for post-transplant biliary stricture. Conclusion: A multidisciplinary team should be used to manage biliary stricture following LDLT. The majority of patients were effectively treated with nonsurgical methods using interventional or endoscopic radiology. Hepaticojejunostomy, a surgical procedure, was performed after both failed. | ||||
| Keywords | ||||
| Biliary stricture; ERCP; Living donor liver transplantation; Percutaneous transhepatic dilatation and stenting | ||||
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