Endoscopic Treatment and Outcome Analysis of Biliary Stricture After Orthotopic Liver Transplantation: A Single Center Retrospective Study.

Abstract

Purpose: The incidence of biliary stricture (BS) after liver transplantation (LT) significantly increases the risks of retransplantation and mortality. Although various endoscopic treatment strategies are available, a consensus is lacking in certain aspects, and the impact of endoscopic treatment on overall survival has yet to be studied. This retrospective study aims to explore factors influencing the efficacy of initial endoscopic treatment for BS after deceased donor orthotopic liver transplantation (OLT) and to analyze outcomes.

Patients and methods: This research conducted a retrospective analysis of 89 patients who developed BS after OLT at The First Hospital of Jilin University between 01/01/2014 and 01/01/2022. Patients were categorized into a successful group (59 patients) and a failed group (30 patients) based on the success or failure of initial endoscopic treatment. Risk factor analysis for initial endoscopic treatment failure in patients with BS after OLT was performed using univariate and multivariate logistic regression analysis. The survival analysis for patients with BS after OLT was conducted using Cox regression and Kaplan-Meier methods.

Results: The failure rate of initial endoscopic treatment was 33.7%. Independent risk factors for failure included the proximal and distal bile duct angle≤145 (OR=16.667, 95% CI: 3.279-83.333, P=0.001), severe stricture (OR=9.009, 95% CI: 1.590-50.000, P=0.013), and non-anastomotic stricture (NABS) type (OR=20.049, 95% CI: 2.663-150.953, P=0.004). Furthermore, failed initial endoscopic treatment (HR=3.205, 95% CI: 1.350-7.634, P=0.008) emerged as an independent risk factor for mortality in patients with BS after OLT.

Conclusion: Initial endoscopic treatment for BS in patients after OLT is effective, safe, and has a high success rate. However, patients with the proximal and distal bile duct angle≤145, NABS, and severe strictures exhibit poorer initial endoscopic treatment effect. Those whose initial endoscopic treatment fails demonstrate significantly worse prognoses.