Multimodal Management for Refractory Biliary Stricture After Living Donor Liver Transplantation |
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| Affiliation: | 1. Department of Kidney Transplantation Surgery, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan;2. Department of Hepato-biliary Pancreatic and Transplantation Surgery, Asahikawa Medical University, Hokkaido, Japan;3. Department of Surgery, Nephrology Center, Toranomon Hospital, Tokyo, Japan;4. Department of Surgery, Tohoku University, Sendai, Japan;5. Department of Urology, Okazaki Medical Center, Fujita Health University, Okazaki, Japan;6. Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, Aichi, Japan;1. Department of Transplantation and Regenerative Medicine, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan;2. Department of Endocrinology, Diabetes and Metabolism, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan;3. Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan;1. Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea;2. Department of Surgery, Graduate School of Medicine, Kangwon National University, Chuncheon-si, Gangwon-do, Republic of Korea;3. Department of Laboratory Medicine, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea |
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| Abstract: | ![]()
BackgroundBiliary stricture is a common complication of living donor liver transplantation (LDLT). Endoscopic retrograde biliary drainage (ERBD) is the primary treatment of biliary stricture, which is sometimes refractory. This study aimed to evaluate the risk factors for biliary stricture after LDLT and present successful management for refractory biliary stricture.MethodsData from 26 patients who underwent LDLT were retrospectively analyzed. The relationship between the incidence of biliary strictures and clinical variables, including pre/intra/postoperative factors, was assessed.ResultsUnivariate analysis showed that ABO incompatibility (P = .037) was a significant risk factor for biliary strictures. Case 1 was a 57-year-old woman who underwent LDLT using a left-lobe graft for primary biliary cholangitis (PBC) and developed a biliary stricture 1 month after surgery. Percutaneous transhepatic cholangiodrainage (PTCD) and embolization of the portal vein and hepatic artery were performed. Thereafter, ethanol was injected into the biliary duct, and the intervention was successfully completed. Case 2 was a 54-year-old woman who underwent LDLT using a right-lobe graft and duct-to-duct biliary reconstruction for PBC. Internal plastic stent insertion by ERBD was unsuccessful due to the significantly bending bile duct. After PTCD, the gun-site technique for the posterior branch and dual hepatic vascular embolization of the anterior branch was performed. The patient was followed up without an external fistula tube.ConclusionABO incompatibility was a risk factor for refractory biliary stricture. Appropriate procedures should be chosen based on stricture types. |
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