Observational Study of Biliary Duct stenosis in patients with Post-Liver Transplant

Introduction and Objectives

Liver transplant is a surgical procedure indicated in terminal hepatic diseases or patients who fail any other type of treatment. Complications of liver transplant are stenosis of biliary tract, with an incidence of 5-25%, which influences both morbidity and mortality.

Nowadays, treatment has evolved with Endoscopic Retrograde Cholangiopancreatography (ERCP). This treatment consists of dilation, prothesis placement and stents.

The main objective of this study consists in describing the clinical characteristics, therapeutic strategies, results and impact in post-liver transplant patients with bile duct stenosis at the National Medical Center “20 de Noviembre”.

Materials and Patients

In this retrospective observational study, a total of 39 post-liver transplant patients who presented bile duct stenosis complications were included, receiving endoscopic treatment from 2018 to 2023 with ERCP at the National Medical Center “20 de Noviembre”.

Results

A total of 39 post-liver transplant patients with bile duct stenosis were included. The mean age was 49.8 years, with equal distribution between genders. The main causes of liver transplantation were autoimmune diseases (41%) and alcohol-induced liver cirrhosis (23%). The immunosuppressive treatment they received consisted of mycophenolate mofetil (MMF), tacrolimus, and prednisone in 92% of the cases. Regarding endoscopic procedures, a total of 163 ERCP were performed, an average of 4 per patient with prosthesis placement in 64%, mainly plastic (64%). Pneumatic dilation was the most used method (64%). The complication related to endoscopic procedure was cholangitis in 17.9%, without pancreatitis. Bile duct rehabilitation was successful in 64%. Three patients presented death, all related to graft rejection.

Conclusions

Bile duct stenosis is a significant complication in post-liver transplant patients, which must be treated individually. Bile duct rehabilitation was successful in more than half of the cases. That said, placement of prosthesis is the most effective strategy in these cases. However, additional research is required to identify success predictors and improve the management of post-transplant complications.

Ethical statement

The protocol was registered and approved by the Ethics Committee. The identity of the patients is protected. Consentment was obtained.

Declaration of interests

None

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Figure 1. Number of bile duct rehabilitiations and remission (N=39)

Figure 2. Etiology of liver transplantation (N=39)