HPB : the official journal of the International Hepato Pancreato Biliary Association · 2026
Treatment of anastomotic biliary strictures after liver transplantation: long-term outcomes and risk factors for failure.
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Halle-Smith James M, Hann Angus, Haldar Debashis, Holt Andrew, Almond Max, Sutcliffe Robert P, Roberts Keith J, Sanabria-Mateos Rebeca
Аннотация
BACKGROUND: Anastomotic biliary strictures (AS) remain a common problem after liver transplantation. To guide treatment decisions and accurately counsel patients, it is important to compare the long-term success and morbidity rates of endoscopic and surgical treatment.
METHODS: Adult recipients of a whole liver graft with duct-to-duct biliary anastomosis between 2013 and 2019 were reviewed. Those who developed AS requiring intervention were identified and the outcomes and morbidity associated with endoscopic and surgical treatment were collected.
RESULTS: Of 1360 total transplants, 90 patients (7%) developed an AS requiring intervention, with a median follow-up of 104 months. Most patients (87, 97%) had endoscopic therapy as first-line. This was successful in 34 (39%) patients with the remainder (53, 61%) requiring further non-endoscopic biliary interventions. Of these, 42 underwent biliary reconstruction, which was successful in the majority of cases (30/42, 91%). A delay from stricture diagnosis to first endoscopic treatment was a risk factor for endoscopic failure (24 days vs 7 days; p = 0.04). The likelihood of success from a surgical repair was significantly greater if it was performed within 2 years of transplantation (100% vs. 72%; p = 0.007).
CONCLUSIONS: Delays to treatment significantly reduce the chance of success for both endoscopic and surgical management of AS.
METHODS: Adult recipients of a whole liver graft with duct-to-duct biliary anastomosis between 2013 and 2019 were reviewed. Those who developed AS requiring intervention were identified and the outcomes and morbidity associated with endoscopic and surgical treatment were collected.
RESULTS: Of 1360 total transplants, 90 patients (7%) developed an AS requiring intervention, with a median follow-up of 104 months. Most patients (87, 97%) had endoscopic therapy as first-line. This was successful in 34 (39%) patients with the remainder (53, 61%) requiring further non-endoscopic biliary interventions. Of these, 42 underwent biliary reconstruction, which was successful in the majority of cases (30/42, 91%). A delay from stricture diagnosis to first endoscopic treatment was a risk factor for endoscopic failure (24 days vs 7 days; p = 0.04). The likelihood of success from a surgical repair was significantly greater if it was performed within 2 years of transplantation (100% vs. 72%; p = 0.007).
CONCLUSIONS: Delays to treatment significantly reduce the chance of success for both endoscopic and surgical management of AS.