TY - JOUR
T1 - Internal biliary stenting during orthotopic liver transplantation
T2 - Anastomotic complications, post-transplant biliary interventions, and survival
AU - Mathur, Amit K.
AU - Nadig, Satish N.
AU - Kingman, Stephanie
AU - Lee, Dustin
AU - Kinkade, Kathleen
AU - Sonnenday, Christopher J.
AU - Welling, Theodore H.
N1 - Publisher Copyright:
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Background: Biliary complications are a leading source of surgical morbidity following orthotopic liver transplantation (OLT). Methods: We examined how prophylactic internal biliary stent placement during OLT affected post-transplant morbidity and mortality in a single-center retrospective cohort study of 513 recipients (2006-2012). Recipient and donor covariates were collected. Biliary complications included major and minor anastomotic leaks, strictures, or stenoses. Multivariate regression models were created to estimate how operative biliary stents affected outcomes. Results: About 87.3% (n = 448) of recipients had a duct-to-duct biliary anastomosis, and 43.1% (n = 221) had biliary stents placed. The biliary complication rate was <15% at five yr, and 44.8% (n = 230) overall. Stenting was not protective from anastomotic biliary complications (p = 0.06). Stenting was associated with a 74% higher adjusted risk of needing multiple endoscopic retrograde cholangiographies (ERCs; odds ratio [OR] 1.74, p = 0.011), and trended toward a lower adjusted risk for repetitive percutaneous transhepatic cholangiography (PTCs; OR 0.56, p = 0.063). Stenting had no effect on the cumulative freedom from biliary complications (p = 0.94). Biliary complications were associated with mortality (HR 1.86, p = 0.014) and was unaffected by stenting (aHR = 0.72, p = 0.246). Conclusions: Biliary stenting during OLT does not deter biliary complications and is associated with higher risk of multiple invasive biliary interventions, particularly ERCs. Surgeons should evaluate the utility of biliary stents at OLT within this context.
AB - Background: Biliary complications are a leading source of surgical morbidity following orthotopic liver transplantation (OLT). Methods: We examined how prophylactic internal biliary stent placement during OLT affected post-transplant morbidity and mortality in a single-center retrospective cohort study of 513 recipients (2006-2012). Recipient and donor covariates were collected. Biliary complications included major and minor anastomotic leaks, strictures, or stenoses. Multivariate regression models were created to estimate how operative biliary stents affected outcomes. Results: About 87.3% (n = 448) of recipients had a duct-to-duct biliary anastomosis, and 43.1% (n = 221) had biliary stents placed. The biliary complication rate was <15% at five yr, and 44.8% (n = 230) overall. Stenting was not protective from anastomotic biliary complications (p = 0.06). Stenting was associated with a 74% higher adjusted risk of needing multiple endoscopic retrograde cholangiographies (ERCs; odds ratio [OR] 1.74, p = 0.011), and trended toward a lower adjusted risk for repetitive percutaneous transhepatic cholangiography (PTCs; OR 0.56, p = 0.063). Stenting had no effect on the cumulative freedom from biliary complications (p = 0.94). Biliary complications were associated with mortality (HR 1.86, p = 0.014) and was unaffected by stenting (aHR = 0.72, p = 0.246). Conclusions: Biliary stenting during OLT does not deter biliary complications and is associated with higher risk of multiple invasive biliary interventions, particularly ERCs. Surgeons should evaluate the utility of biliary stents at OLT within this context.
KW - Bile duct
KW - Biliary complications
KW - Liver transplant
KW - Stenting
UR - http://www.scopus.com/inward/record.url?scp=84927909392&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84927909392&partnerID=8YFLogxK
U2 - 10.1111/ctr.12518
DO - 10.1111/ctr.12518
M3 - Article
C2 - 25604635
AN - SCOPUS:84927909392
SN - 0902-0063
VL - 29
SP - 327
EP - 335
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 4
ER -