Comparative study of rendezvous techniques in post-liver transplant biliary stricture

Table 1 Patient characteristics and procedural outcomes

	Guidewire group(n = 19)	KMP catheter group(n = 19)	P-value
Mean age, yr (SD)	51.3 (9.3)	52.5 (10.2)	0.619
Male sex (%)	13 (68)	15 (79)	0.714
Pretransplantation liver disease (%)			0.524
End-stage liver cirrhosis	5 (26)	8 (42)
Hepatitis B	2	6
Hepatitis B and alcohol	2	1
Cryptogenic	1	1
Hepatocellular carcinoma	9 (47)	6 (32)
Hepatitis B	9	5
Hepatitis C	0	1
Fulminant hepatitis	5 (26)	5 (26)
Hepatitis A	1	2
Hepatitis B	3	3
Unknown origin	1	0
Mean duration between LDLT and rendezvous procedure, d (SD)	338 (197)	438 (516)	0.704
Mean duration between PTBD and rendezvous procedure, d (SD)	91 (52)	217 (351)	0.511
Mean anastomotic angle1, ° (SD)	118 (15)	125 (17)	0.148
Mean no. of PTBD catheters, (SD)	1.4 (0.5)	1.2 (0.4)	0.517
Mean diameter of PTBD catheter, F (SD)	10.7 (2.8)	9.1 (2.2)	0.365
Pre-laboratory findings2, mean (SD)
WBC (× 109/L)	4.61 (1.80)	4.87 (1.98)	0.569
Total bilirubin (mg/dL)	1.37 (0.90)	1.60 (1.51)	0.988
Alanine aminotransaminase (IU/L)	60.6 (41.6)	90.2 (128)	0.748
Alkaline phosphatase (IU/L)	332 (173)	289 (175)	0.649
γ-glutamyl transferase (IU/L)	248 (179)	278 (203)	0.800
Rendezvous success rate (%)	19 (100)	19 (100)	1.000
No. of stents inserted, mean (SD)	1.5 (0.5)	1.5 (0.5)	0.749
Inside stent diameter (F), mean (SD)	10.4 (2.7)	9.8 (0.7)	0.308
CBD or IHD stones (%)	0 (0)	2 (11)	0.152
Stricture dilation (%)	4 (21)	0 (0)	0.037
Mean procedure time3, s (range)	2037 (251-6758)	1012 (301-2006)	0.022
Post-laboratory findings4, mean (SD)
White blood cell (× 109/L)	5.19 (1.88)	6.18 (2.34)	0.215
Total bilirubin (mg/dL)	2.15 (1.61)	2.11 (1.51)	0.942
Alanine aminotransaminase (IU/L)	85.1 (67.3)	115 (136)	0.953
Alkaline phosphatase (IU/L)	341 (167)	312 (198)	0.419
γ-glutamyl transferase (IU/L)	279 (189)	368 (319)	0.531
Amylase (U/L)	284 (585)	207 (241)	0.737
Complications			0.740
Acute cholangitis	1	0
Hyperamylasemia	5	6
Acute pancreatitis	1	2
Migration of stents	1	0

¹Between the right hepatic duct of the donor and the common bile duct of the recipient;

²One day before the rendezvous technique;

³Time after positioning the end of the duodenoscope in front of the major ampulla until placement of the inside stents;

⁴One day after the rendezvous procedure. LDLT: Living donor liver transplantation; PTBD: Percutaneous transhepatic biliary drainage; KMP: Kumpe; CBD: Common bile duct; IHD: Intrahepatic duct.

Table 2 Univariate analysis of factors related to procedure time

Factors		n	Procedure time, s, mean (range)	P-value
Rendezvous	Guidewire	19	2037 (251-6758)	0.022
Technique	KMP catheter	19	1012 (301-2006)
IHD or CBD	Present	2	1517 (1202-1831)	0.513
Stone	Absent	36	1525 (251-6758)
No. of inside stents	One	19	1198 (251-5144)	0.04
	Two	19	1851 (666-6758)
Operator	Lee IS	31	1292 (251-6758)	0.024
	Chang JH	7	2555 (735-5144)
Balloon dilation	Yes	4	2568 (2189-2895)	0.008
of the stricture	No	34	1402 (251-6758)
Age	< 60	29	1571 (251-6758)	0.904
	> 60	9	1373 (301-2895)
Procedure	First half2	15	1009 (368-1934)	0.635
Familiarity1	Second half	16	1557 (251-6758)

¹Performed by Lee IS;

²The rendezvous procedures were performed for the first half of each rendezvous group. KMP: Kumpe; CBD: Common bile duct; IHD: Intrahepatic duct.

Table 3 Multivariate analysis of factors related to procedure time

Factors	P-value	Odds ratio (95%CI)
Rendezvous technique (guidewire vs rendezvous)	0.010	2.663 (1.258-5.637)
No. of inside stents (1 vs 2)	0.067
Operator (Lee IS vs Chang JH)	0.195
Balloon dilation (yes vs no)	0.289

CI: Confidence interval.