Abstract
Purpose
To investigate clinical outcomes and safety of extraluminal recanalization for duct-to-duct anastomotic obstruction after living donor liver transplantation (LDLT).
Materials and Methods
Extraluminal recanalization was performed as a salvage procedure after failure of intraluminal cannulation in eight patients who underwent percutaneous transhepatic treatment of duct-to-duct anastomotic obstruction 11.0 ± 5.27 months after LDLT between October 2012 and April 2019. Technical details, safety, and outcomes of extraluminal recanalization were investigated.
Results
Total ten sessions of extraluminal recanalization were performed in the eight patients with the stiff backend of a 0.035 inch hydrophilic guide wire, 22-gauge Chiba needle, or Colapinto needle. Percutaneous common bile duct access was performed in three sessions to obtain a straight course for the puncture. There was one instance of subcapsular and intraparenchymal hematoma requiring placement of an additional drainage catheter and conservative treatment. During a follow-up period ranging from 18.4 to 100.7 months, the drainage catheter was removed in seven of the eight patients, including three patients who had recurrent stricture requiring repeat percutaneous treatment and one who underwent a routine change of an endoscopic retrograde biliary drainage catheter.
Conclusions
Extraluminal recanalization can be an effective and safe salvage procedure after failed intraluminal cannulation of duct-to-duct anastomotic obstruction in LDLT.
References
Akamatsu N, Sugawara Y, Hashimoto D. Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: a systematic review of the incidence, risk factors and outcome. Transpl Int. 2011;24(4):379–92.
Chok KS, Lo CM. Biliary complications in right lobe living donor liver transplantation. Hepatol Int. 2016;10(4):553–8.
Rao HB, Prakash A, Sudhindran S, Venu RP. Biliary strictures complicating living donor liver transplantation: problems, novel insights and solutions. World J Gastroenterol. 2018;24(19):2061–72.
Nakamura T, Tanaka K, Kiuchi T, et al. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases. Transplantation. 2002;73(12):1896–903.
Olthoff KM, Merion RM, Ghobrial RM, et al. Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL Consortium. Ann Surg. 2005;242(3):314–23 (discussion 323–315).
Ko GY, Sung KB, Yoon HK, Kim KR, Gwon DI, Lee SG. Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation. Liver Transplant. 2008;14(9):1323–32.
Gwon DI, Sung KB, Ko GY, Yoon HK, Lee SG. Dual catheter placement technique for treatment of biliary anastomotic strictures after liver transplantation. Liver Transplant. 2011;17(2):159–66.
Mukund A, Choudhury A, Das S, Pamecha V, Sarin SK. Salvage PTBD in post living donor liver transplant patients with biliary complications—a single centre retrospective study. Br J Radiol. 2020;93(1108):20191046.
Choo SW, Shin SW, Do YS, et al. The balloon dilatation and large profile catheter maintenance method for the management of the bile duct stricture following liver transplantation. Korean J Radiol. 2006;7(1):41–9.
Kulkarni CB, Prabhu NK, Kader NP, Rajeshkannan R, Pullara SK, Moorthy S. Percutaneous transhepatic techniques for management of biliary anastomotic strictures in living donor liver transplant recipients. Indian J Radiol Imaging. 2017;27(1):92–9.
Kamiya S, Nagino M, Kanazawa H, et al. The value of bile replacement during external biliary drainage: an analysis of intestinal permeability, integrity, and microflora. Ann Surg. 2004;239(4):510–7.
Kim EH, Lee HG, Oh JS, Chun HJ, Choi BG. Extraluminal recanalization of bile duct anastomosis obstruction after liver transplantation. J Vasc Interv Radiol. 2018;29(10):1466–71.
Gwon DI, Ko GY, Ko HK, Yoon HK, Sung KB. Percutaneous transhepatic treatment using retrievable covered stents in patients with benign biliary strictures: mid-term outcomes in 68 patients. Dig Dis Sci. 2013;58(11):3270–9.
Ye P, Zeng Q, Miao H, Pang H, Chen Y. Percutaneous treatment of benign biliary anastomotic strictures: retrievable covered self-expandable metal stent with fixation string versus large-bore catheters. J Vasc Interv Radiol. 2021;32(1):113–20.
Battistel M, Senzolo M, Ferrarese A, et al. Biodegradable biliary stents for percutaneous treatment of post-liver transplantation refractory benign biliary anastomotic strictures. Cardiovasc Interv Radiol. 2020;43(1):749–55.
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This study was not supported by any funding.
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The protocol conformed to ethical guidelines of the World Medical Association Declaration of Helsinki and was approved by the Institutional Review Board of the National Cancer Center (No. NCC2021-0017).
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The requirement for informed consent from patients was waived owing to the retrospective nature of the study.
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Kim, H.B., Lee, I.J., Kim, S.H. et al. Extraluminal Recanalization for Biliary Duct-to-Duct Anastomotic Obstruction After Living Donor Liver Transplantation: Experience in Eight Patients. Cardiovasc Intervent Radiol 44, 1266–1272 (2021). https://doi.org/10.1007/s00270-021-02826-0
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DOI: https://doi.org/10.1007/s00270-021-02826-0