ERC and PTCD in biliary strictures after liver transplantation: long-term outcome predictors and influence on patient survival.

BACKGROUND & AIMS: Biliary strictures are common complications after orthotopic liver transplantation (OLT). Endoscopic retrograde cholangiography (ERC) evolved as standard and percutaneous transhepatic cholangiodrainage (PTCD) as alternative therapy. This study analysed predictors of long-term success of biliary strictures after ERC and/or PTCD and its impact on patient survival.

METHODS: All adult patients with biliary strictures receiving ERC and/or PTCD between 2009 and 2015 at the University Medical Center Hamburg-Eppendorf were retrospectively analysed. Potential predictors of long-term success (>12 months) were identified by univariate and logistic regression analyses. Patient survival was analysed by Kaplan-Meier method and log-rank test.

RESULTS: Hundred-sixteen patients were treated with ERC and/or PTCD, including 67 patients with anastomotic strictures (AS), 22 with non-anastomotic strictures (NAS) and 27 with both stricture types. Eighty-five patients received ERC, 17 PTCD and 14 both techniques. Long-term success was achieved in 60 patients (52%). Predictors of treatment failure were a pre-interventional C-reactive protein (CRP) >8g/dl in AS (p=0.039) and a body mass index (BMI) ≤21kg/m² in NAS (p=0.021). In patients who received ERC only, balloon dilatation of AS with larger diameters favoured success (p=0.015). Achievement of long-term success was associated with prolonged patient survival in AS (p=0.036) and NAS (p=0.025), but not in combined strictures (p=0.739).

CONCLUSION: In post-OLT biliary strictures treated by ERC and/or PTCD, patient BMI and pre-interventional CRP may influence prognosis. ERC with larger balloon-diameter may favour success in AS. Long-term success by ERC and/or PTCD is associated with superior survival in patients with AS and NAS only. This article is protected by copyright. All rights reserved.