Surgical Outcome and Proposed Strategy for Biliary Stricture after Living Donor Liver Transplantation: A Single Center Analysis

Background/Aims: To clarify the surgical outcome and propose an appropriate strategy for biliary stricture (BS) treatment after living donor liver trans, plantation (LDLT). Methodology: Among 53 patients who underwent LDLT at our institute, 45 patients had duct-to-duct anastomosis. Of these, 33 who survived for at least 12 months after LDLT comprised the study group. Clinical parameters, BS treatment outcomes, and predictive factors for long-term patency were investigated. Results: Eleven patients developed BS. Binary leakage occurred significantly more frequently, and the number of external biliary tubes Was significantly lower than the number of graft bile-duct Openings, in the BS group compared with the non-BS group (p=0.001 and 0.004). Multivariate analysis showed that the number of external biliary tubes was the only risk factor. Long-term patency was achieved in two patients in whom stents were retained for more than 20 months, which was significantly longer than in other patients (p=0.01). Identical stent-retention for more than 6 months was a risk factor for cholangitis. Conclusions : The number of external biliary tubes should match the number of graft bile-duct openings. When BS occurs, the duration of stent retention should be more than 20 months, and stents should be exchanged at least every 6 months.