BILIARY STRICTURES IN HEPATIC TRANSPLANTS - PREVALENCE AND TYPES IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS VS THOSE WITH OTHER LIVER-DISEASES

OBJECTIVE. The purpose of this study was to determine the prevalence a nd types of biliary strictures seen in liver allografts transplanted f or primary sclerosing cholangitis and other end-stage liver diseases a nd to determine if such strictures occur more often in the allografts transplanted for primary sclerosing cholangitis than in the others. MA TERIALS AND METHODS. During a 10-year period, 643 liver transplantatio n patients (687 allografts) with choledochojejunostomy biliary anastom oses underwent 1728 cholangiographic studies. Three hundred six cholan giograms were obtained in 100 transplant recipients who had primary sc lerosing cholangitis (112 allografts) and 1422 cholangiograms were obt ained in 543 recipients who had other liver diseases (575 allografts). We retrospectively reviewed all cholangiograms of transplant recipien ts who had primary sclerosing cholangitis and 909 cholangiograms of th e recipients who had other liver diseases and a diagnosis of biliary s trictures, possible biliary strictures, or duct irregularity based on radiologic reports. The presence, number, and locations of strictures were recorded. The remaining 513 cholangiograms of recipients with oth er liver diseases without strictures were not reviewed. Biliary strict ures were classified as intrahepatic (including bifurcation), anastomo tic, and nonanastomotic extrahepatic. RESULTS. Cholangiograms showed i ntrahepatic biliary strictures in 105 allografts (15%), anastomotic st rictures in 105 allografts (15%), and nonanastomotic extrahepatic bili ary strictures in 17 allografts (2%). Intrahepatic biliary strictures were diagnosed in 27% (30/112) of the allografts transplanted for prim ary sclerosing cholangitis and in 13% (75/575) of the allografts trans planted for other end-stage liver diseases (p = .0005). Anastomotic st rictures developed in 18% (20/112) of the allografts transplanted for primary sclerosing cholangitis and in 15% (85/575) of the others (p = .381). Nonanastomotic extrahepatic strictures were seen in 6% (7/112) of the allografts transplanted for primary sclerosing cholangitis and in 2% (10/575) of the others (p = .008). CONCLUSION. Intrahepatic and nonanastomotic extrahepatic biliary strictures are significantly more common in patients who have liver transplantation for primary sclerosi ng cholangitis than in patients who receive allografts for other end-s tage liver diseases. However, strictures at the choledochojejunostomy anastomosis occur with equal frequency in both groups of patients.