Abstract
The rate of biliary complications in transplant recipients in published series ranges from 8% to 35%. This complication rate is higher for living-related liver transplant (LRLT) than for orthotopic liver transplantation (OLT) patients. Anastomotic stricture (AS) is the most common biliary complication; ERCP is currently considered the diagnostic gold standard for transplant patients with suspected biliary stricture of the duct-to-duct anastomosis, allowing a direct approach for interventional procedures. Several studies evaluated the endoscopic treatment of biliary complications in patients with duct-to-duct biliary reconstruction showing a success rate of approximately 70–80% in cases of OLTx and about 60% in LRLTx cases. The current therapeutic option consists in sphincterotomy, progressive pneumatic dilatation, and multiple stent placements. Another option consists in placement of a fully covered metal stent (FC-SEMS) across the stricture. This approach requires only two ERCP procedures but carries a high stent migration rate. Recently, the sequential additional approach, where multiple plastic stents are inserted and placed side by side across the stricture, was described with interesting results. The outcomes of non-anastomotic strictures (NAS) are not as favorable as AS. These complications result mainly from hepatic artery thrombosis or other forms of ischemia. Only 50% of these patients have a favorable long-term response with endoscopic therapy. In fact, up to 50% of patients with NAS undergo retransplantation or die.
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Tarantino, I. (2022). Treatment of Post-liver Transplant Strictures. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-56993-8_79
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DOI: https://doi.org/10.1007/978-3-030-56993-8_79
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