Diagnosis and Management of Post-Liver Transplant Biliary Obstruction: A 1300 Patient Single-Center Experience.
Academic Article
Overview
abstract
BACKGROUND: Biliary tract obstruction (BTO) is a common complication following liver transplantation (LT) with high potential for morbidity. A comprehensive assessment of post-LT BTO, including patient and intraoperative characteristics predictive of postoperative obstruction, remains lacking. STUDY DESIGN: A prospectively collected database of all LTs performed at a single-center institution from 2014-2022 was analyzed. Diagnostic methods utilized in the evaluation of post-LT biliary obstruction were correlated with clinical data to identify high-yield diagnostic modalities. Subsequently, management strategies were analyzed to identify therapeutic approaches associated with optimal patient outcomes. RESULTS: Of 1,302 primary LT recipients, 137 (10.5%) experienced a post-transplant biliary obstruction event. Median time to post-LT BTO was 150 (68 - 275) days. 119 obstruction events (86.9%) were attributable to anastomotic strictures, 11 (8.03%) to ischemic cholangiopathy, and 7 (5.1%) to T-tube or stent obstruction. On receiver operator characteristic (ROC) analysis, Gamma-glutamyl transferase (GGT) demonstrated superior predictive power (AUC 0.80, 95% CI 0.69 - 0.91) in the detection of post-LT BTO as compared to total bilirubin (AUC 0.64, 95% CI 0.50 - 0.78) and alkaline phosphatase (AUC 0.57, 95% CI 0.41-0.72). History of coronary artery disease (OR 4.26, p=0.03) and postoperative hepatic artery thrombosis (OR 6.01, p=0.001) independently predicted stricture recurrence following an attempted stent-free trial. CONCLUSION: Obstruction of the biliary ductal system remains a common complication post-LT, with most cases occurring within one year of transplant. GGT demonstrates superior sensitivity and specificity in the detection of post-LT BTO and may be of significant diagnostic utility. Following an initial stent-free trial, several key risk factors may identify patients who merit additional monitoring for stricture recurrence.
