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  • Title: Surgical outcome and proposed strategy for biliary stricture after living donor liver transplantation: a single center analysis.
    Author: Takeda K, Tanaka K, Kumamoto T, Nojiri K, Mori R, Taniguchi K, Matsuyama R, Kubota K, Kobayashi N, Endo I.
    Journal: Hepatogastroenterology; 2013 May; 60(123):577-80. PubMed ID: 23282735.
    Abstract:
    BACKGROUND/AIMS: To clarify the surgical outcome and propose an appropriate strategy for biliary stricture (BS) treatment after living donor liver transplantation (LDLT). METHODOLOGY: Among 53 patients who underwent LDLT at our institute, 45 patients had duct-to-duct anastomosis. Of these, 33 who survived for at least 12 months after LDLT comprised the study group. Clinical parameters, BS treatment outcomes, and predictive factors for long-term patency were investigated. RESULTS: Eleven patients developed BS. Biliary leakage occurred significantly more frequently, and the number of external biliary tubes was significantly lower than the number of graft bile-duct openings, in the BS group compared with the non-BS group (p=0.001 and 0.004). Multivariate analysis showed that the number of external biliary tubes was the only risk factor. Long-term patency was achieved in two patients in whom stents were retained for more than 20 months, which was significantly longer than in other patients (p=0.01). Identical stent-retention for more than 6 months was a risk factor for cholangitis. CONCLUSIONS: The number of external biliary tubes should match the number of graft bile-duct openings. When BS occurs, the duration of stent retention should be more than 20 months, and stents should be exchanged at least every 6 months.
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