Stoklosa T1*, Staudenmann D1, Liu K1,3, Baars JE1, Su F1, Perera N1, Hu XX1, Tsoutsman T1,3,Rogan C2, Waugh R2, Majumdar A1,3, Kaffes A1,3 and Saxena P1,3
1AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
2Department of Radiology, Royal Prince Alfred Hospital, Australia
3University of Sydney School of Medicine, Australia
Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP), EUS-guided Biliary Drainage (EUS-BD) or Double Balloon enteroscopy assisted-ERCP (DB-ERCP) are commonly used to manage biliary complications after Liver Transplant (LT). Percutaneous Transhepatic Biliary Drainage (PTBD) remains second-line treatment in patients after LT; however it has not been well studied, particularly in Deceased Donor Liver Transplantation (DDLT). We aimed to determine the efficacy and safety of PTBD in this setting.
Methods: This is a retrospective study of patients who underwent PTBD for biliary obstruction post DDLT at a quaternary referral centre between1st of January 2003 and 1st of September 2019. Technical success was defined as successful biliary cannulation and treatment. Clinical success was defined as a 50% reduction in serum bilirubin 7 days post-procedure and/or a 75% reduction at 4 weeks.
Results: 58 LT patients underwent 232 PTBDs (83% male, median age 55 [IQR 47 to 58] years). The most common underlying liver diseases were Primary Sclerosing Cholangitis (PSC) 16 (28%) and hepatitis C 15 (26%). Thirty (52%) patients had hilar and intra-hepatic strictures, 18 (31%) had surgical bilio-enteric anastomotic strictures and 10 (17%) patients had duct-to-duct anastomotic strictures. Clinical success was achieved in 27 (47%) patients and technical success in 53 (91%) patients. Complications occurred in 32 (55%) patients. Seven (12%) patients died within 90 days of PTBD.
Conclusion: Although technical success for PTBD post LT is high, clinical success is modest at 47% with complications occurring in the majority of patients. PTBD carries a significant risk of adverse events in this complex patient population.
Biliary complications after liver transplantation; Deceased donor liver transplantation; Percutaneous transhepatic biliary drainage
Stoklosa T, Staudenmann D, Liu K, Baars JE, Su F, Perera N, et al. Clinical Success and Safety of Percutaneous Transhepatic Biliary Drainage for Biliary Obstruction after Deceased Donor Liver Transplantation. J Gastroenterol Hepatol Endosc. 2021; 6(1): 1090..