Management issues in post living donor liver transplant biliary strictures

Table 1 Evolution of post living donor liver transplant biliary complications with the changing time

Ref.	Year	Country	n	Follow-up (mo)	Leaks	Strictures
Sugawara et al[4]	2003	Japan	92	45	20.6%	9.7%
Gondolesi et al[5]	2004	United States	96	24.2	21.9%	22.9%
Lee et al[6]	2004	South Korea	31	10.5	6.5%	12.9%
Liu et al[7]	2004	China	41	13.3	7.3%	24.3%
Soejima et al[8]	2006	Japan	182	21	11.5%	25.3%
Shah et al[9]	2007	Canada	128	23	14.8%	17.1%
Mita et al[10]	2008	Japan	231			9.5%
Marubashi et al[11]	2009	Japan	83	32.4	1.2%	7.2%
Kim et al[12]	2010	South Korea	22	51.3	0%	9.1%
Wadhawan et al[14]	2013	India	65	28	8.8%	10.3%
Mizuno et al[13]	2014	Japan	108	58.4	5.6%	13.9%
Vij et al[15]	2015	India	127	9.32	0.7%	0%

Table 2 Overview of factors contributing to biliary complications

Ref.	Year	Factor	Inference
Dalgic et al[16]	2005	Corner sparing sutures	Decreased incidence of complications
Castaldo et al[17]	2007	Continuous vs interrupted sutures	No difference in two techniques
Soejima et al[18]	2008	Hilar dissection to preserve blood supply	Decreased incidence of complications
Lin et al[19]	2009	Microsurgical biliary reconstruction	Decreased incidence of complications
Kim et al[12]	2010	Telescopic reconstruction of bile duct	Decreased incidence of complications
Chok et al[20]	2011	CIT and acute cellular rejection	Higher biliary complications with increased CIT
			Acute cellular rejection predicted biliary strictures
Horster et al[21]	2013	HCV infection as etiology	Higher incidence of biliary complications in patients with HCV infection and higher viral load
Wadhawan et al[14]	2013	Type of anastomosis	Higher incidence of biliary complications in double duct and cystic duct anastomosis
Mathur et al[22]	2015	Internal biliary stenting	No difference in complications with or without stenting Decreased incidence of biliary complications
Vij et al[15]	2015	Corner sparing sutures
		Bile duct mucosal eversion

CIT: Cold ischemia time; HCV: Hepatitis C virus.

Table 3 Definitions

Term	Definition
Anastomotic biliary stricture	ERCP/PTC - Dominant narrowing at the anastomotic site without effective drainage of the contrast material
	MRCP - More than 50% reduction in anastomotic diameter compared to intrahepatic duct
Successful initial endoscopic outcome	Stricture negotiated with stent with continuous improvement in liver functions
Successful long-term endoscopic outcome	Persistent patency of the anastomotic site on cholangiography after stent removal (anastomotic site > 80% of intrahepatic ductal diameter)
Initial endoscopic treatment failure	Inability to negotiate the stricture on ERCP
Endoscopic treatment failure	Persistence of the stricture after 12 mo of therapy
Persistent ABS	Visible stricture on cholangiography after stent removal, measuring less than 80% of the diameter of the intrahepatic duct or hindering effective drainage of contrast medium
Recurrence of stricture	Biochemical derangement with ERCP documented recurrence of stricture after initial success

ERCP: Endoscopic retrograde cholangiopancreatography; PTC: Percutaneous transhepatic cholangiography; ABS: Anastomotic biliary strictures; MRCP: Magnetic resonance cholangiopancreatography.