Significance of proximal biliary dilatation in patients with anastomotic strictures after liver transplantation

The goal of this study was to evaluate the significance of biliary dilatation proximal to the level of obstruction in liver transplant recipients with anastomotic strictures. A retrospective review of all liver transplants with duct-to-duct biliary reconstruction performed at our institution was conducted to identify patients with anastomotic stricture. Maximum diameter of the donor bile duct proximal to the stricture was measured from cholangiographic images taken at diagnosis and most recent follow-up. The change in duct size during this time was compared between those who responded to treatment (responder group) and those who did not (nonresponder group). Mean maximum duct diameter at diagnosis in the responder group was 10.1 mm at diagnosis and 12.1 mm at follow-up. This compared to a mean of 10.6 mm at diagnosis and 12.4 mm at follow-up in the nonresponder group. This corresponded to an average change in duct size between diagnosis and follow-up of +1.9 mm in the responders and +1.8 mm in the nonresponders. In posttransplant patients with obstructive cholestasis, duct dilatation does not correlate with clinically significant obstruction. Further, the change in duct size after treatment is not indicative of cholangiographic improvement.