Z Gastroenterol 2018; 56(01): E2-E89
DOI: 10.1055/s-0037-1612732
Poster Visit Session II Clinical Hepatology – Friday, January 26, 2018, 2:35pm – 3:20pm, Room 120
Georg Thieme Verlag KG Stuttgart · New York

Does long-term remission by endoscopic treatment modalities benefit patient and graft survival in biliary strictures after liver transplantation?

M Heinemann
1   University Hospital Hamburg-Eppendorf, I. Medical Clinic and Polyclinic, Hamburg
,
B Tafrishi
1   University Hospital Hamburg-Eppendorf, I. Medical Clinic and Polyclinic, Hamburg
,
S Pischke
1   University Hospital Hamburg-Eppendorf, I. Medical Clinic and Polyclinic, Hamburg
,
L Fischer
2   University Hospital Hamburg-Eppendorf, Department of Hepatobiliary Surgery and Transplantation, Hamburg
,
T Rösch
3   University Hospital Hamburg-Eppendorf, Department for Interdisciplinary Endoscopy, Hamburg
,
A Lohse
1   University Hospital Hamburg-Eppendorf, I. Medical Clinic and Polyclinic, Hamburg
,
M Sterneck
1   University Hospital Hamburg-Eppendorf, I. Medical Clinic and Polyclinic, Hamburg
,
U Denzer
3   University Hospital Hamburg-Eppendorf, Department for Interdisciplinary Endoscopy, Hamburg
4   University Hospital of Marburg, Department of Gastroenterology, Marburg
› Author Affiliations
Further Information

Publication History

Publication Date:
03 January 2018 (online)

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Question:

Biliary strictures are among the most common complications after orthotopic liver transplantation (OLT). Recent studies report an increased rate of graft loss and mortality in patients with biliary complications. Interventional endoscopic retrograde cholangiography (ERC) evolved as the standard treatment in most centres, while percutaneous transhepatic cholangiodrainage (PTCD) is available as an alternative approach. This study aims to determine the impact of long-term remission of biliary strictures by ERC and PTCD on patient and graft survival.

Methods:

All adult patients who received ERC or PTCD for biliary strictures after OLT between 2009 and 2015 were retrospectively analysed. Long-term remission was defined as no need of intervention for at least 12 months. The impact of long-term remission on patient and graft survival was investigated using the Kaplan-Meier method with log-rank test. Patient survival was calculated from diagnosis of biliary stricture to death or last follow-up, graft survival was defined as the time from stricture diagnosis to re-transplantation or last follow-up. Survival was adjusted for age, gender, primary liver disease and type of biliary stricture using inverse probability weighting.

Results:

A total of 116 patients who were treated with ERC or PTCD for biliary strictures were identified, including 55 patients with anastomotic stricture, 21 with non-anastomotic strictures and 23 with both stricture types. While 86 of 116 patients (74%) were treated by ERC alone, 17 (15%) received PTCD and 13 (11%) were treated with both techniques. Long-term remission was achieved in 60 of 116 patients (52%). After a follow-up time of up to 7.4 years (median, 2.9 years) from diagnosis of biliary stricture, the patient survival was 81% and the graft survival 96%. Patient survival was superior if long-term remission was achieved (median, 3.8 versus 1.8 years, p < 0.001). Also, the graft survival rate was higher after remission (median, 3.8 versus 1.3 years, p = 0.039).

Conclusion:

Long-term remission of post-transplantation biliary strictures by ERC or PTCD is associated with superior patient and graft survival.