Background and study aims: Anastomotic strictures are an important cause of morbidity after orthotopic liver
transplantation (OLT). Endoscopic treatment is the primary treatment modality for
biliary complications after OLT. The outcome and complications of a progressive stenting
protocol are largely unknown.
Patients and methods: A longitudinal cohort study of OLTs was conducted. Only patients with late strictures
were included. Treatment success was defined as cholangiographic stricture resolution
and liver enzymes returning to normal with follow-up of at least 12 months.
Results: Between May 2000 and June 2009, 375 OLTs were performed. A duct-to-duct anastomosis
was created in 304 cases (81 %). In 63 patients (21 %; 95 % confidence interval [CI]
16.5 % – 25.6 %) an anastomotic stricture developed and progressive stenting was started
in 35. During treatment two patients died of a non-treatment-related cause and two
patients underwent a second OLT during stent therapy. Therefore 31 patients were available
for analysis (male : female 21:10; median age 61 years, range 28 – 75 years). Progressive
stenting required a median number of 5 endoscopic retrograde cholangiopancreatography
(ERCP) procedures (range 4 – 11). A median maximum of 4 stents (range 2 – 8) were
inserted. A total of 21 patients (67.7 %; 95 %CI 50.1 % – 81.4 %) developed a treatment-related
complication. In 33 out of a total of 155 ERCPs (21.3 %) a complication occurred:
cholangitis (n = 12), transient cholestasis (n = 11), post-ERCP pancreatitis (n = 7),
and treatment-related pain (n = 3). The median follow-up time after stent removal
was 28 months (range 12 – 92). Treatment was successful in 25 patients (80.6 %; 95 %CI
63.7 % – 90.8 %).
Conclusion: Progressive stenting for anastomotic strictures after OLT is demanding and burdensome,
necessitating a median of 5 ERCP procedures with complications occurring in one out
of five procedures. Its success rate however is high (81 %), avoiding surgery in the
large majority of patients.
