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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2017; 27(01): 92-99
DOI: 10.4103/0971-3026.202950
Interventional Radiology

Percutaneous transhepatic techniques for management of biliary anastomotic strictures in living donor liver transplant recipients

Chinmay B Kulkarni
Department of Radiology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India
,
Nirmal K Prabhu
Department of Radiology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India
,
Nazar P Kader
Department of Radiology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India
,
Ramiah Rajeshkannan
Department of Radiology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India
,
Sreekumar K Pullara
Department of Radiology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India
,
Srikanth Moorthy
Department of Radiology, Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Aim: To retrospectively analyze the percutaneous transhepatic techniques and their outcome in the management of biliary strictures in living donor liver transplant (LDLT) recipients. Materials and Methods: We retrieved the hospital records of 400 LDLT recipients between 2007 and 2015 and identified 45 patients with biliary strictures. Among them, 17 patients (37.8%) (Male: female = 13:4; mean age, 36.1 ± 17.5 years) treated by various percutaneous transhepatic biliary techniques alone or in combination with endoscopic retrograde cholangiopancreatography (ERCP) were included in the study. The technical and clinical success of the percutaneous management was analyzed. Results: Anastomotic strictures associated with leak were found in 12/17 patients (70.6%). Ten out of 12 (83.3%) patients associated with leak had more than one duct-duct anastomoses (range, 2–3). The average duration of onset of stricture in patients with biliary leak was 3.97 ± 2.68 months and in patients with only strictures it was 14.03 ± 13.9 months. In 6 patients, endoscopic-guided plastic stents were placed using rendezvous technique, plastic stent was placed from a percutaneous approach in 1 patient, metallic stents were used in 2 patients, cholangioplasty was performed in 1 patient, N-butyl- 2-cyanoacrylate embolization was done in 1 child with biliary-pleural fistula, internal-external drain was placed in 1 patient, and only external drain was placed in 5 patients. Technical success was achieved in 12/17 (70.6%) and clinical success was achieved in 13/17 (76.5%) of the patients. Posttreatment mean time of follow-up was 19.4 ± 13.7 months. Five patients (29.4%) died (two acute rejections, one metabolic acidosis, and two sepsis). Conclusions: Percutaneous biliary techniques are effective treatment options with good outcome in LDLT patients with biliary complications.

Keywords

Biliary tract - cholangiopancreatography - endoscopic retrograde - liver transplantation - stricture


Publication History

Article published online:
27 July 2021

© 2017. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Yazumi S, Chiba T. Biliary complications after a right-lobe living donor liver transplantation. J Gastroenterol 2005;40:861-5.
  • 2 Verdonk RC, Buis CI, Porte RJ, Van der Jagt EJ, Limburg AJ, Van den Berg AP, et al. Anastomotic biliary strictures after liver transplantation: Causes and consequences. Liver Transpl 2006;12:726-35.
  • 3 Greif F, Bronsther OL, Van Thiel DH, Casavilla A, Iwatsuki S, Tzakis A, et al. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg 1994;219:40-5.
  • 4 Mosca S, Militerno G, Guardascione MA, Amitrano L, Picciotto FP, Cuomo O. Late biliary tract complications after orthotopic liver transplantation: Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography. J Gastroenterol Hepatol 2000;15:654-60.
  • 5 Thethy S, Thomson B, Pleass H, Wigmore SJ, Madhavan K, Akyol M, et al. Management of biliary tract complications after orthotopic liver transplantation. Clin Transplant 2004;18:647-53.
  • 6 Khuroo MS, Al Ashgar H, Khuroo NS, Khan MQ, Khalaf HA, Al-Sebayel M, et al. Biliary disease after liver transplantation: The experience of the King Faisal Specialist Hospital and Research Center, Riyadh. J Gastroenterol Hepatol 2005;20:217-28.
  • 7 Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation: Past, present and preventive strategies. Liver Transpl 2008;14:759-69.
  • 8 Leoni CJ, Potter JE, Rosen MP, Brophy DP, Lang EV. Classifying complications of interventional procedure: A survey of practicing radiologists. J Vasc Interv Radiol 2001;12:55-9.
  • 9 Gondolesi GE, Varotti G, Flormann SS, Munoz L, Fishbein TM, Emre SH, et al. Biliary complications in 96 consecutive right lobe living donor transplant recipients. Transplantation 2004;77:1842-8.
  • 10 Shah SA, Grant DR, McGilvray ID, Greig PD, Selzer M, Lilly LB, et al. Biliary strictures in 130 consecutive right lobe living donor liver transplant recipients: Results of a Western center. Am J Transplant 2007;7:161-7.
  • 11 Egawa H, Inomata Y, Uemoto S, Asonuma K, Kiuchi T, Fujita S, et al. Biliary anastomotic complications in 400 living related liver transplantations. World J Surg 2001;25:1300-7.
  • 12 Atwal T, Pastrana M, Sandhu B. Post-liver Transplant Biliary Complications. J Clin Exp Heptol 2012;2:81-5.
  • 13 Welling TH, Heidt DG, Englesbe MJ, Magee JC, Sung RS, Campbell DA, et al. Biliary complications following liver transplantation in the model for end-stage liver disease era: Effect of donor, recipient, and technical factors. Liver Transpl 2008;14:73-80.
  • 14 Graziadei IW, Schwaighofer H, Koch R, Nachbaur K, Koenigsrainer A, Margreiter R, et al. Long-term outcome of treatment of biliary strictures after liver transplantation. Liver Transpl 2006;12:718-25.
  • 15 Guichelaar MMJ, Benson J, Malinchoc M, Krom RAF, Wiesner R, Charlton M. Risk factors for and clinical course of non-anastomotic biliary strictures after liver transplantation. Am J Transpl 2003;3:885-90.
  • 16 Kulkarni CB, Pullara SK, Moorthy S, Prabhu NK, Nazar PK, Kannan RR. Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: Analysis of technique and long-term outcome. Gastrointest Interv 2015;4:112-9.
  • 17 Ryan ME, Geenen JE, Lehman GA, Aliperti G, Freeman ML, Silverman WB, et al. Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy: A multicenter review. Gastrointest Endosc 1998;47:261-6.
  • 18 Bergman JJ, Van den Brink GR, Rauws EA, De Wit L, Obertop H, Huibregtse K, et al. Treatment of bile duct lesions after laparoscopic cholecystectomy. Gut 1996;38:141-7.
  • 19 Brady AP, Malone DE, Deignan RW, O'Donovan N, McGrath FP. Fibrin sealant in interventional radiology: A preliminary evaluation. Radiology 1995;196:573-8.
  • 20 Kusano T, Kida H, Nishiwaki Y, Ikematsu Y, Goto K, Kuroda H, et al. Percutaneous sclerotherapy for intractable external biliary after hepatectomy. Int Surg 2003;88:72-5.
  • 21 Sadakari Y, Miyoshi A, Ohtsuka T, Kohya N, Takahashi T, Matsumoto K, et al. Percutaneous transhepatic portal embolization for persistent bile leakage after hepatic resection: Report of a case. Surg Today 2008;38:668-71.
  • 22 Kyokane T, Nagino M, Sano T, Nimura Y. Ethanol ablation for segmental bile duct leakage after hepatobiliary resection. Surgery 2002;131:111-3.
  • 23 Soehendra N, Nam VC, Grimm H, Kempeneers I. Endoscopic obliteration of large esophagogastric varices with bucrylate. Endoscopy 1986;18:25-6.
  • 24 Görich J, Rilinger N, Sokiranski R, Siech M, Vogel J, Wikström M, et al. Percutaneous transhepatic embolization of bile duct fistulas. J Vasc Interv Radiol 1996;7:435-8.
  • 25 Cerecedo-Rodriguez J, Phillips M, Figueroa-Barojas P, Kumer SC, Gaidhane M, Schmitt T, et al. Self expandable metal stents for anastomotic stricture following liver transplant. Dig Dis Sci 2013;58:2661-6.
  • 26 Kaffes A, Griffin S, Vaughan R, James M, Chua T, Tee H, et al. A randomized trial of a fully covered self-expandable metallic stent versus plastic stents in anastomotic biliary strictures after liver transplantation. Therap Adv Gastroenterol 2014;7:64-71.
  • 27 Civelli EM, Meroni R, Cozzi G, Milella M, Suman L, Vercelli R, et al. The role of interventional radiology in biliary complications after orthotopic liver transplantation: A single-center experience. Eur Radiol 2004;14:579-82.
  • 28 Roumilhac D, Poyet G, Sergent G, Declerck N, Karoui M, Mathurin P, et al. Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation. Liver Transpl 2003;9:394-400.
  • 29 Sung RS, Campbell DA Jr, Rudich SM, Punch JD, Shieck VL, Armstrong JM, et al. Long-term follow-up of percutaneous transhepatic balloon cholangioplasty in the management of biliary strictures after liver transplantation. Transplantation 2004;77:110-5.
  • 30 Zajko AB, Sheng R, Zetti GM, Madariaga JR, Bron KM. Transhepatic balloon dilation of biliary strictures in liver transplant patients: A 10-year experience. J Vasc Interv Radiol 1995;6:79-83.
  • 31 Ozden I, Tekant Y, Bilge O, Acarli K, Alper A, Emre A, et al. Endoscopic and radiologic interventions as the leading causes of severe cholangitis in a tertiary referral center. Am J Surg 2005;189:702-6.
  • 32 Ginat D, Saad WE, Davies MG, Saad NE, Waldman DL, Kitanosono T. Incidence of cholangitis and sepsis associated with percutaneous transhepatic biliary drain cholangiography and exchange: A comparison between liver transplant and native liver patients. AJR Am J Roentgenol 2011;196:73-7.