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01-07-2020 | Liver Transplantation | Original Article

Is Surgery Necessary? Endoscopic Management of Post-transplant Biliary Complications in the Modern Era

Authors: Alexander R. Cortez, Mackenzie C. Morris, Nicholas G. Brown, Leah K. Winer, Kamran Safdar, Sampath Poreddy, Shimul A. Shah, R. Cutler Quillin III

Published in: Journal of Gastrointestinal Surgery | Issue 7/2020

Abstract

Background

Biliary complications are common following liver transplantation (LT) and traditionally managed with Roux-en-Y hepaticojejunostomy. However, endoscopic management has largely supplanted surgical revision in the modern era. Herein, we evaluate our experience with the management of biliary complications following LT.

Methods

All LTs from January 2013 to June 2018 at a single institution were reviewed. Patients with biliary bypass prior to, or at LT, were excluded. Patients were grouped by biliary complication of an isolated stricture, isolated leak, or concomitant stricture and leak (stricture/leak).

Results

A total of 462 grafts were transplanted into 449 patients. Ninety-five (21%) patients had post-transplant biliary complications, including 56 (59%) strictures, 28 (29%) leaks, and 11 (12%) stricture/leaks. Consequently, the overall stricture, leak, and stricture/leak rates were 12%, 6%, and 2%, respectively. Endoscopic management was pursued for all stricture and stricture/leak patients, as well as 75% of leak patients, reserving early surgery only for those patients with an uncontrolled leak and evidence of biliary peritonitis. Endoscopic management was successful in the majority of patients (stricture 94%, leak 90%, stricture/leak 90%). Only six patients (5.6%) received additional interventions—two required percutaneous transhepatic cholangiography catheters, three underwent surgical revision, and one was re-transplanted.

Conclusions

Endoscopic management of post-transplant biliary complications resulted in long-term resolution without increased morbidity, mortality, or graft failure. Successful endoscopic treatment requires collaboration with a skilled endoscopist. Moreover, multidisciplinary transplant teams must develop treatment protocols based on the local availability and expertise at their center.

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Title: Is Surgery Necessary? Endoscopic Management of Post-transplant Biliary Complications in the Modern Era
Authors: Alexander R. Cortez
Mackenzie C. Morris
Nicholas G. Brown
Leah K. Winer
Kamran Safdar
Sampath Poreddy
Shimul A. Shah
R. Cutler Quillin III
Publication date: 01-07-2020
Publisher: Springer US
Keywords: Liver Transplantation
Endoscopy
Liver Transplantation
Liver Transplantation
Liver Transplantation
Liver Transplantation
Published in: Journal of Gastrointestinal Surgery / Issue 7/2020
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04292-z

At a glance: The STEP trials

Springer Medicine

Is Surgery Necessary? Endoscopic Management of Post-transplant Biliary Complications in the Modern Era

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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