Bile Leak Grade Is Associated with Healing Time and Subsequent Biliary Stricture After Liver Transplantation.

Abstract

Background and aims: Biliary leaks after liver transplantation predispose to strictures, but leak-specific endoscopic strategies remain heterogeneous. We evaluated leak- and procedure-related factors associated with time to closure and 12-month stricture.

Methods: Single-center retrospective cohort (Jan 2020-Jun 2024) of adults with radiologically confirmed biliary leaks treated by ERCP within 24 h. Leaks were graded (high vs low) and timed (early ≤ 4 weeks vs late).

Primary outcome: days to closure, defined by imaging confirmation of no ongoing extravasation on follow-up ERCP cholangiography (or MRCP when ERCP was not repeated).

Secondary outcome: biliary stricture within 12 months.

Results: Thirty-four patients were analyzed. Median time to closure was 16 days (IQR, 10-25). Mean time to closure was longer for early than for late leaks (21.1 vs. 13.0 days, respectively; p = 0.01). In multivariable models, high-grade leak and an ERCP interval ≥ 1 month were factors associated with delayed closure, whereas an initial 10 Fr plastic stent was associated with lower odds of delayed closure (time to closure > 16 days) in univariable analyses. Within 12 months, 18/33 (54.5%) developed strictures; this occurred in 18/19 (94.7%) high-grade leaks and 0/14 (0%) low-grade leaks; in multivariable models, timing and stent caliber were not significant.

Conclusion: In this single-center cohort, leak grade was associated with both healing time and stricture risk. These findings suggest that leak grade may be useful for risk stratification and could help inform the intensity of endoscopic surveillance. However, grade-based treatment strategies require prospective validation before clinical implementation.