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Endoscopic Management of Biliary Leaks and Strictures After Living Donor Liver Transplantation: Optimizing Techniques for Successful Management

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Abstract

Background and Aims

Biliary complications (BCs) occur in up to 40% of living donor liver transplant (LDLT) recipients. The aim of this study was to evaluate the efficacy of endoscopic therapy in the management of LDLT-related BCs.

Methods

A retrospective study of 100 LDLT recipients at a single transplant center over a 9-year period was conducted. BC was defined as a biliary leak and/or a stricture. Patient records were used to identify time to diagnosis, type of intervention, and time to resolution.

Results

BCs occurred in 46 (46%) patients; median follow-up was 4.6 years (range 5 days–9.3 years); and median time to diagnosis was 37.5 days (range 1 day–3.5 years). BCs were classified as a leak in 6 (6%), stricture in 22 (22%), and a leak + stricture in 18 (18%). ERCP was the initial treatment modality in 43/46 (93%) patients and was completed in 42/43 (98%). Three (6.5%) patients with a leak underwent surgery as the primary treatment approach. The median time to resolution of BCs was 91.5 days (range 21–367). Thirteen patients had a recurrence which was managed with endoscopic therapy alone.

Conclusions

Endoscopic therapy was successful in almost all patients (98%) and ERCP alone resulted in successful treatment in a higher proportion of patients (93%) than traditionally reported. Advanced endoscopic techniques obviate the need for PTC and/or surgery and allow successful management in almost all LDLT recipients presenting with BC and in patients with recurrence of strictures.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, 406 Harvard St. SE, MMC 36, Minneapolis, MN, 55455, USA

    Saleh Elwir, Julie Thompson, Stuart K. Amateau, Guru Trikudanathan, Rajeev Attam, Mohamed Hassan, John Lake & Mustafa A. Arain

  2. Division of Solid Organ Transplant, University of Minnesota, Minneapolis, MN, USA

    Raja Kandaswamy, Timothy Pruett, John Lake, Srinath Chinnakotla & Martin L. Freeman

Authors
  1. Saleh Elwir
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  2. Julie Thompson
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  3. Stuart K. Amateau
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  4. Guru Trikudanathan
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  5. Rajeev Attam
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  6. Mohamed Hassan
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  7. Raja Kandaswamy
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  8. Timothy Pruett
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  9. John Lake
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  10. Srinath Chinnakotla
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  11. Martin L. Freeman
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  12. Mustafa A. Arain
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Corresponding author

Correspondence to Mustafa A. Arain.

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Conflict of interest

Drs. Freeman, Amateau, and Arain are consultants for Boston Scientific.

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Elwir, S., Thompson, J., Amateau, S.K. et al. Endoscopic Management of Biliary Leaks and Strictures After Living Donor Liver Transplantation: Optimizing Techniques for Successful Management. Dig Dis Sci 62, 244–252 (2017). https://doi.org/10.1007/s10620-016-4367-z

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  • DOI: https://doi.org/10.1007/s10620-016-4367-z

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