Korean J Transplant.  2022 Nov;36(Supple 1):S225. 10.4285/ATW2022.F-3614.

Significant association between warm ischemic time and posttransplant biliary stricture

• Sakamoto K
• Ogawa K
• Tamura K
• Funamizu N
• Honjo M
• Nagaoka T
• Uraoka M
• Yusuke N
• Matsui T
• Takada Y

• KMID: 2535442
• DOI: http://doi.org/10.4285/ATW2022.F-3614

Abstract

Background
Biliary stricture after liver transplantation is unsolved issue. The aim of the present study is to detect the predic-tive factor of biliary stricture after liver transplantation.
Methods
From January 2010 to March 2022, we retrospectively reviewed the 83 patients underwent liver transplantation in Ehime University Hospital. Of the 83 patients, 12 patients of within 90-day mortality were excluded and 71 patients were en-rolled. Definition of biliary stricture was the patients required biliary stenting for elevated liver enzymes/bilirubin or cholangitis.
Results
Posttransplant biliary stricture occurred in the 25 (35.2%) patients and the median day from transplantation to biliary stenting was 121 days (range, 42–1,162 days). Of 25 patients, 21 were anastomotic stricture and four were non-anastomotic stricture. No significant differences were observed in incompatible blood type, cold ischemic time, and number of bile ducts between the group with biliary stricture and that of not. In the log-rank test comparing the occurrence of biliary stricture generated by Kaplan-Meier method, postoperative complication (Clavien-Dindo classification 3), biliary leakage, intraoperative es-timated blood loss >68 mL/kg, intraoperative red cell transfusion 0.2 U/kg, intraoperative final portal vein pressure >16 mmHg, and warm ischemic time >60 minutes showed significantly higher rate of biliary stricture (P=0.013, P<0.0001, P=0.001, P<0.001, P=0.006, and P=0.013). In multivariate analyses using Cox-hazard model, intraoperative red cell transfusion 0.2 U/kg (hazard ratio [HR], 6.776; 95% confidence interval [CI], 2.469–18.591), intraoperative final portal vein pressure >16 mmHg (HR, 4.587; 95% CI, 1.664–12.645), and warm ischemic time >47/60 minutes and >60 minutes (HR, 14.420, 27.044; 95% CI, 1.793–115.995, 3.128– 233.775) were selected as independent predictor of biliary stricture.
Conclusions
Long warm ischemic time was associated with posttransplant biliary stricture.