ENDOSCOPIC MANAGEMENT OF BILIARY STRICTURES IN LIVER-TRANSPLANT RECIPIENTS - EFFECT ON PATIENT AND GRAFT-SURVIVAL

Background: Biliary strictures in liver transplant recipients cause si gnificant morbidity and can lead to reduced patient and graft survival . Methods: Of 251 liver transplant recipients, 22 patients with biliar y strictures were categorized into two groups: donor hepatic duct (n = 12) or anastomotic (n = 10). Strictures were dilated and stented. End oscopic therapy was considered successful if a patient did not require repeat stenting or dilation for 1 year. Results: Patient and graft su rvival did not differ significantly in the 22 patients compared with p atients without strictures (relative risk of death and graft survival 1.8 and 1.3). Donor hepatic duct strictures required significantly lon ger therapy than anastomotic strictures (median days 185 versus 67, p = 0.02). Twenty-two months after the first endoscopic treatment, 73% o f the donor hepatic duct stricture group were stent free compared with 90% of the anastomotic group (p = 0.02). The former group had signifi cantly more (p < 0.05) hepatic artery thrombosis (58.3% versus 10%), c holangitis (58.3% versus 30%), choledocholithiasis (91% versus 10%), a nd endoscopic interventions. No patient undergoing endoscopic treatmen t required retransplantation or biliary reconstruction during a median follow-up of 35.7 months. Conclusion: Endoscopic therapy of biliary s trictures after liver transplantation is effective and is not accompan ied by reduced patient or graft survival.