Biliary anastomotic stricture after adult living donor liver transplantation with duct-to-duct reconstruction: Outcome after endoscopic treatment including rendezvous procedure

Background. To evaluate the outcomes and investigate the factors associated with restricture after endoscopic treatment. Methods. Between April 2001 and July 2014, 98 patients experienced biliary anastomotic stricture (BAS) after living donor liver transplantation (LDLT) with duct-to-duct reconstruction, and all were first referred to Okayama University Hospital for endoscopic stent deployment.When deployment was unsuccessful, a percutaneous transhepatic procedure was used. Treatment outcomes, including stricture resolution, BAS recurrence, and risk factors of BAS recurrence, were evaluated retrospectively. Results. Successful stent deployment was achieved in 90 of 98 patients (91.8%) by both procedures. Among the 90 patients, stricture resolution was eventually observed in 72. The median number of endoscopic retrograde cholangiographies performed was 5. After a median follow-up period of 48.8 months from stent removal, BAS recurrence that required intervention occurred in 22 patients (30.6%). In multivariate analysis, portal vein stenosis after LDLTwas associated with BAS recurrence after endoscopic treatment (P = 0.03). Among the 22 patients who required reintervention, 16 (73%) had their stents removed, and recurrence after retreatment occurred in 3 patients (18.8%).Conclusions. Endoscopic treatment is a useful procedure for the treatment for BAS after LDLT with duct-to-duct reconstruction. Portal vein stenosis may be one of the risks associated with the recurrence of BAS.