Korean J Transplant.  2023 Nov;37(Suppl 1):S180. 10.4285/ATW2023.F-7666.

Late occurrence of nonanastomotic biliary stricture after liver transplantation

• Thwin CM
• Swe NN
• Nyunt Oo SA
• Mar TT

• KMID: 2551800
• DOI: http://doi.org/10.4285/ATW2023.F-7666

Abstract

Biliary complications after liver transplantation are not uncommon and it is still a challenging problem in post operative period. Biliary strictures are classified into anastomotic biliary stricture and nonanastomotic biliary stricture. We would like to present about a case of late occurrence of nonanastomotic biliary stricture which occurred 46 months after liver transplantation. He underwent living donor liver transplantation from his niece with low graft-to-recipient weight ratio 0.51 with adequate outflow with two right inferior hepatic veins. Cold ischemic time was just 1 hour 27 minutes. Arterial reconstruction had to be done three times during operation due to intima damage and dissection. Bile duct anastomosis was with tailored telescopic reconstruction. Postoperative period was uneventful and no complications were detected until 48 months follow-up. Yellow sclera was noted and liver function tests at that time was total bilirubin 145 µmol/L and alkaline phosphate 359 U/L. Intrahepatic biliary dilatations were noted in ultrasonography and computed tomography and magnetic resonance cholangiopancreatography (MRCP) were proceeded. Both right anterior and posterior sectoral ducts were dilated with stricture at bifurcation was noted in MRCP. Endoscopic retrograde cholangiopancreatography (ERCP) and stenting was done. Several cannulations must be done due to difficult cannulation and failed to remove previous stents. Now ERCP was done 11 times stent was changed five times with plastic stents in both anterior and posterior sectoral ducts. Biliary cirrhosis and portal hypertension was present in imaging. Enzyme levels were decreasing but not satisfactorily. This patient developed strictures only after 48 months of transplant which is unusual. Although he had some difficulties in arterial anastomosis during operation, no hepatic artery thrombosis was detected in postoperative period and follow up. We will have to do further investigations and work up to know the etiology of nonanastomotic biliary strictures and their management.