TY - JOUR
T1 - Biliary stricture in living-related donor liver transplantation
T2 - Management with balloon dilation
AU - Schwarzenberg, Sarah Jane
AU - Sharp, Harvey L.
AU - Payne, William D.
AU - Hunter, David W.
AU - Bjarnason, Haraldur
AU - Humar, Abhinav
AU - Weisdorf-Schindele, Sally A.
AU - Gruessner, Rainer W.
PY - 2002
Y1 - 2002
N2 - Biliary stricture is a recipient graft complication, occurring late in the post-operative period, which appears to occur with increased frequency in living-related donor liver transplantation (LRD LTx). We reviewed the experience at the University of Minnesota in managing a biliary complication of LRD LTx. Since January 1997, 13 LRD transplants have been performed using the technique of transplantation of the left lateral segments with a small portion of segment IV. All patients had hepaticojejunostomies using a Roux-en-Y loop. Of the 11 surviving patients, eight had evidence of cholangitis (Gram-negative sepsis, two patients; ascending cholangitis, three patients; or unexplained fever with elevated liver enzymes, three patients) 4-8 months after otherwise successful transplantation. Six of the patients underwent percutaneous transhepatic cholangiography (PTC) with demonstration of a stenosis at the site of the biliary anastomosis. Repeated dilation of the anastomosis led to resolution of the stenoses, normalization of liver enzymes, and prevention of further episodes of infection. No patient required revision of the hepaticojejunostomy. Computed axial tomography evidence of ductal stenosis may be subtle in this group of patients, but PTC is diagnostic. We suggest a high index of suspicion of biliary stricture in the LRD LTx population. Biliary dilation reduces the risk of life-threatening sepsis.
AB - Biliary stricture is a recipient graft complication, occurring late in the post-operative period, which appears to occur with increased frequency in living-related donor liver transplantation (LRD LTx). We reviewed the experience at the University of Minnesota in managing a biliary complication of LRD LTx. Since January 1997, 13 LRD transplants have been performed using the technique of transplantation of the left lateral segments with a small portion of segment IV. All patients had hepaticojejunostomies using a Roux-en-Y loop. Of the 11 surviving patients, eight had evidence of cholangitis (Gram-negative sepsis, two patients; ascending cholangitis, three patients; or unexplained fever with elevated liver enzymes, three patients) 4-8 months after otherwise successful transplantation. Six of the patients underwent percutaneous transhepatic cholangiography (PTC) with demonstration of a stenosis at the site of the biliary anastomosis. Repeated dilation of the anastomosis led to resolution of the stenoses, normalization of liver enzymes, and prevention of further episodes of infection. No patient required revision of the hepaticojejunostomy. Computed axial tomography evidence of ductal stenosis may be subtle in this group of patients, but PTC is diagnostic. We suggest a high index of suspicion of biliary stricture in the LRD LTx population. Biliary dilation reduces the risk of life-threatening sepsis.
KW - Bile duct
KW - Complication
KW - Liver transplantation
UR - http://www.scopus.com/inward/record.url?scp=0036256619&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0036256619&partnerID=8YFLogxK
U2 - 10.1034/j.1399-3046.2002.01053.x
DO - 10.1034/j.1399-3046.2002.01053.x
M3 - Article
C2 - 12000469
AN - SCOPUS:0036256619
SN - 1397-3142
VL - 6
SP - 132
EP - 135
JO - Pediatric transplantation
JF - Pediatric transplantation
IS - 2
ER -