Management of Post-transplant Biliary Stricture after Living Donor Liver Transplant in Adult Recipients.

Document Type : Original Article

Authors

1 Departments of HepatoPancreaticobiliary Surgery, National Liver Institute, Menoufia University, Egypt

2 Departments of Diagnostic and Interventional Radiology, National Liver Institute, Menoufia University, Egypt

3 Departments 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

The Egyptian Journal of Surgery
Volume 44, Issue 2
April 2025
Pages 752-759

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