TY - JOUR
T1 - Endoscopic management of biliary complications after adult living donor liver transplantation
AU - Shah, Janak N.
AU - Ahmad, Nuzhat A.
AU - Shetty, Kirti
AU - Kochman, Michael L.
AU - Long, William B.
AU - Brensinger, Colleen M.
AU - Pfau, Patrick R.
AU - Olthoff, Kim
AU - Markmann, James
AU - Shaked, Abraham
AU - Reddy, K. Rajender
AU - Ginsberg, Gregory G.
PY - 2004/7
Y1 - 2004/7
N2 - OBJECTIVES: Biliary complications and their treatment in adult cadaveric liver transplantation (CLT) are well described. However, biliary complications and their management in living donor liver transplantation (LDLT) are not well characterized. We assessed the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and management of biliary complications following LDLT. METHODS: We performed a retrospective cohort analysis of all LDLT recipients with duct-to-duct anastomoses (n = 15). Specific data included referral for ERCP, diagnosis, and therapy. Comparisons were made to a 260 CLT recipient cohort. RESULTS: Greater percentage of LDLT recipients underwent ERCP (73%) compared to CLT recipients (25%; p = 0.001). Biliary complications diagnosed by ERCP in LDLT recipients consisted of bile leaks and strictures, and were more frequent than in CLT recipients (leaks: 53% vs 12%; p = 0.001; strictures: 27% vs 5%; p = 0.01). Most leaks occurred at T-tube sites (LDLT: 87%; CLT: 65%). Diagnosis and therapy of leaks required a median of 2 ERCP procedures in both groups. Bile leaks were successfully treated endoscopically in 100% and 84% of LDLT and CLT recipients, respectively (p = 0.56). Most biliary strictures were anastomotic (LDLT: 100%; CLT: 64%). Strictures were diagnosed and treated with a median of 1.5 and 2 ERCP procedures in the LDLT and CLT groups, respectively. The duration of endoscopic therapy was a median of 10 and 14 wk, and success rates were 75% and 62% (p = 1.0) in LDLT and CLT groups, respectively. CONCLUSIONS: LDLT is associated with increased biliary complications as compared to CLT. ERCP is useful for diagnosis, can successfully treat most LDLT-related biliary complications, and should be attempted prior to more invasive interventions.
AB - OBJECTIVES: Biliary complications and their treatment in adult cadaveric liver transplantation (CLT) are well described. However, biliary complications and their management in living donor liver transplantation (LDLT) are not well characterized. We assessed the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and management of biliary complications following LDLT. METHODS: We performed a retrospective cohort analysis of all LDLT recipients with duct-to-duct anastomoses (n = 15). Specific data included referral for ERCP, diagnosis, and therapy. Comparisons were made to a 260 CLT recipient cohort. RESULTS: Greater percentage of LDLT recipients underwent ERCP (73%) compared to CLT recipients (25%; p = 0.001). Biliary complications diagnosed by ERCP in LDLT recipients consisted of bile leaks and strictures, and were more frequent than in CLT recipients (leaks: 53% vs 12%; p = 0.001; strictures: 27% vs 5%; p = 0.01). Most leaks occurred at T-tube sites (LDLT: 87%; CLT: 65%). Diagnosis and therapy of leaks required a median of 2 ERCP procedures in both groups. Bile leaks were successfully treated endoscopically in 100% and 84% of LDLT and CLT recipients, respectively (p = 0.56). Most biliary strictures were anastomotic (LDLT: 100%; CLT: 64%). Strictures were diagnosed and treated with a median of 1.5 and 2 ERCP procedures in the LDLT and CLT groups, respectively. The duration of endoscopic therapy was a median of 10 and 14 wk, and success rates were 75% and 62% (p = 1.0) in LDLT and CLT groups, respectively. CONCLUSIONS: LDLT is associated with increased biliary complications as compared to CLT. ERCP is useful for diagnosis, can successfully treat most LDLT-related biliary complications, and should be attempted prior to more invasive interventions.
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U2 - 10.1111/j.1572-0241.2004.30775.x
DO - 10.1111/j.1572-0241.2004.30775.x
M3 - Article
C2 - 15233667
AN - SCOPUS:3843096142
VL - 99
SP - 1291
EP - 1295
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
SN - 0002-9270
IS - 7
ER -