Biliary strictures in hepatic transplants: prevalence and types in patients with primary sclerosing cholangitis vs those with other liver diseases

Abstract

Objective: The purpose of this study was to determine the prevalence and types of biliary strictures seen in liver allografts transplanted for primary sclerosing cholangitis and other end-stage liver diseases and to determine if such strictures occur more often in the allografts transplanted for primary sclerosing cholangitis than in the others.

Materials and methods: During a 10-year period, 643 liver transplantation patients (687 allografts) with choledochojejunostomy biliary anastomoses underwent 1728 cholangiographic studies. Three hundred six cholangiograms were obtained in 100 transplant recipients who had primary sclerosing cholangitis (112 allografts) and 1422 cholangiograms were obtained in 543 recipients who had other liver diseases (575 allografts). We retrospectively reviewed all cholangiograms of transplant recipients who had primary sclerosing cholangitis and 909 cholangiograms of the recipients who had other liver diseases and a diagnosis of biliary strictures, possible biliary strictures, or duct irregularity based on radiologic reports. The presence, number, and locations of strictures were recorded. The remaining 513 cholangiograms of recipients with other liver diseases without strictures were not reviewed. Biliary strictures were classified as intrahepatic (including bifurcation), anastomotic, and nonanastomotic extrahepatic.

Results: Cholangiograms showed intrahepatic biliary strictures in 105 allografts (15%), anastomotic strictures in 105 allografts (15%), and nonanastomotic extrahepatic biliary strictures in 17 allografts (2%). Intrahepatic biliary strictures were diagnosed in 27% (30/112) of the allografts transplanted for primary sclerosing cholangitis and in 13% (75/575) of the allografts transplanted for other end-stage liver diseases (p = .0005). Anastomotic strictures developed in 18% (20/112) of the allografts transplanted for primary sclerosing cholangitis and in 15% (85/575) of the others (p = .381). Nonanastomotic extrahepatic strictures were seen in 6% (7/112) of the allografts transplanted for primary sclerosing cholangitis and in 2% (10/575) of the others (p = .008).

Conclusion: Intrahepatic and nonanastomotic extrahepatic biliary strictures are significantly more common in patients who have liver transplantation for primary sclerosing cholangitis than in patients who receive allografts for other end-stage liver diseases. However, strictures at the choledochojejunostomy anastomosis occur with equal frequency in both groups of patients.