Korean J Gastroenterol.  2022 May;79(5):217-221. 10.4166/kjg.2022.034.

Liver Graft Failure after Plastic Stent Removal of an Anastomotic Biliary Stricture

• Chun JW
• Yi NJ
• Kim H
• Paik WH

• KMID: 2530329
• DOI: http://doi.org/10.4166/kjg.2022.034

Abstract

A biliary anastomotic stricture developed 13 months after living donor liver transplantation in a 19-year-old male with congenital hepatic fibrosis. Endoscopic management with balloon dilation followed by the placement of a 7F plastic stent was performed for the anastomotic stricture. After 6 months of indwelling of the stent, the plastic stent was removed because the stenosis and cholestasis were improved. One month after stent removal, he was admitted for acute liver graft failure owing to cholestatic hepatitis, and required retransplantation secondary to graft loss.

Keyword

Constriction; pathologic; Cholestasis; extrahepatic; Liver transplantation; Liver failure

Figure

• 

  Fig. 1 (A) Computed tomography revealed no change in the subtle soft tissue density around bile duct anastomosis (arrow) with (B) mild intrahepatic dilatation (arrowhead). (C) Endoscopic retrograde cholangiopancreatography revealed anastomotic stricture (arrow). (D) A 4mm balloon dilation of anastomotic stricture was performed, (E) followed by the placement of a 7F plastic stent. (F) Follow cholangiography showed an improved biliary stricture (arrow), and the plastic stent was removed.

• 

  Fig. 2 (A) Computed tomography revealed an increased moderated amount of ascites, (B) and mild right intrahepatic dilatation (arrowhead). (C) Cholangiography showed anastomotic stricture (arrow). (D) Two guidewires were passed through the anastomotic stricture (E) then two 7F plastic stents were placed after balloon dilation.

• 

  Fig. 3 Microscopic features of the explanted liver specimen. The entire parenchyme demonstrated the features of cholestatic hepatitis, including marked canalicular and hepatocellular cholestasis, feathery degeneration, and lobular inflammation. Biliary-type bridging fibrosis was seen (hematoxylin and eosin stain, ×100).

Reference

1. Tsujino T, Isayama H, Kogure H, Sato T, Nakai Y, Koike K. 2017; Endoscopic management of biliary strictures after living donor liver transplantation. Clin J Gastroenterol. 10:297–311. DOI: 10.1007/s12328-017-0754-z. PMID: 28600688.

2. Villa NA, Harrison ME. 2015; Management of biliary strictures after liver transplantation. Gastroenterol Hepatol (N Y). 11:316–328.

3. Sharma S, Gurakar A, Jabbour N. 2008; Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl. 14:759–769. DOI: 10.1002/lt.21509. PMID: 18508368.

4. Williams ED, Draganov PV. 2009; Endoscopic management of biliary strictures after liver transplantation. World J Gastroenterol. 15:3725–3733. DOI: 10.3748/wjg.15.3725. PMID: 19673012. PMCID: PMC2726449.

5. Liu CL, Fan ST, Lo CM, et al. 2006; Operative outcomes of adult-to-adult right lobe live donor liver transplantation: a comparative study with cadaveric whole-graft liver transplantation in a single center. Ann Surg. 243:404–410. DOI: 10.1097/01.sla.0000201544.36473.a2. PMID: 16495707. PMCID: PMC1448929.

6. Gómez CM, Dumonceau JM, Marcolongo M, et al. 2009; Endoscopic management of biliary complications after adult living-donor versus deceased-donor liver transplantation. Transplantation. 88:1280–1285. DOI: 10.1097/TP.0b013e3181bb48c2. PMID: 19996927.

7. Ayoub WS, Esquivel CO, Martin P. 2010; Biliary complications following liver transplantation. Dig Dis Sci. 55:1540–1546. DOI: 10.1007/s10620-010-1217-2. PMID: 20411422.

8. You MS, Paik WH, Choi YH, et al. 2019; Optimal biliary drainage for patients with biliary anastomotic strictures after right lobe living donor liver transplantation. Liver Transpl. 25:1209–1219. DOI: 10.1002/lt.25472. PMID: 30980451.

9. Costamagna G, Pandolfi M, Mutignani M, Spada C, Perri V. 2001; Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents. Gastrointest Endosc. 54:162–168. DOI: 10.1067/mge.2001.116876. PMID: 11474384.

10. Seo JK, Ryu JK, Lee SH, et al. 2009; Endoscopic treatment for biliary stricture after adult living donor liver transplantation. Liver Transpl. 15:369–380. DOI: 10.1002/lt.21700. PMID: 19326412.

11. Pasha SF, Harrison ME, Das A, et al. 2007; Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: outcomes after maximal stent therapy. Gastrointest Endosc. 66:44–51. DOI: 10.1016/j.gie.2007.02.017. PMID: 17591473.

12. Srinath A, Shneider BL. 2012; Congenital hepatic fibrosis and autosomal recessive polycystic kidney disease. J Pediatr Gastroenterol Nutr. 54:580–587. DOI: 10.1097/MPG.0b013e31824711b7. PMID: 22197937. PMCID: PMC4369775.

13. Habib S, Shakil O, Couto OF, et al. 2006; Caroli's disease and orthotopic liver transplantation. Liver Transpl. 12:416–421. DOI: 10.1002/lt.20719. PMID: 16498655.

14. Alazmi WM, Fogel EL, Watkins JL, et al. 2006; Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation. Endoscopy. 38:571–574. DOI: 10.1055/s-2006-925027. PMID: 16802268.

15. Kashyap R, Jain A, Reyes J, et al. 2001; Causes of retransplantation after primary liver transplantation in 4000 consecutive patients: 2 to 19 years follow-up. Transplant Proc. 33:1486–1487. DOI: 10.1016/S0041-1345(00)02563-X.

16. Chen GH, Fu BS, Cai CJ, et al. 2008; A single-center experience of retransplantation for liver transplant recipients with a failing graft. Transplant Proc. 40:1485–1487. DOI: 10.1016/j.transproceed.2008.01.076. PMID: 18589134.