Korean J Transplant.  2023 Nov;37(Suppl 1):S231. 10.4285/ATW2023.F-8221.

Biliary stricture of duct-to-duct anastomosis in living donor liver transplantation for hepatocellular carcinoma previously treated with external beam radiotherapy

• Na B
• Jung DH
• Hwang S
• Kim KH
• Moon DB
• Ha TY
• Song GW
• Park GC
• Lee SG

• KMID: 2551851
• DOI: http://doi.org/10.4285/ATW2023.F-8221

Abstract

Background
External beam radiotherapy (EBRT) has been proven to provide acceptable oncologic outcomes in selected patients with hepatocellular carcinoma (HCC) followed by adult living donor liver transplantation (LDLT). The study aims to evaluate the biliary stricture (BS) after LDLT in patients with HCC previously treated with EBRT.
Methods
We retrospectively enrolled 50 patients with HCC treated with EBRT, who underwent duct-to-duct anastomosis during LDLT using a single right graft between January 2019 and December 2020. The perihilar EBRT was defined as RT including a 10mm expansion area surrounding the right, left, and common hepatic duct. We identified the risk factors for BS by analyzing the LDLT and EBRT factors.
Results
During a median follow-up period of 23.2 months (range, 6.3–36.2 months), a total of 17 patients (34%) presented BS after LDLT for HCC previously treated with EBRT. In a comparative analysis between BS and no BS groups, the patients with perihilar EBRT in the BS group were significantly more than those in the no BS group (47.1% vs. 15.2%, P=0.021). In a univariate analysis of risk factors for BS, warm ischemic time (odd ratio [OR), 1.06; 95% confidence interval [CI], 1.00–1.14; P=0.08] and perihilar EBRT (OR, 4.98; 95% CI, 1.33–20.47; P=0.019) were significantly associated with BS. In a multivariate analysis, perihilar EBRT was identified as the only significant risk factor for BS (OR, 4.37; 95% CI, 1.13–18.4; P=0.036).
Conclusions
Perihilar EBRT for HCC before LDLT can lead to BS of duct-to-duct anastomosis. Hepaticojejunostomy may be an option for the prevention of BS after LDLT for patients with HCC previously treated with the perihilar EBRT.