Ann Hepatobiliary Pancreat Surg.  2022 Feb;26(1):76-83. 10.14701/ahbps.21-103.

Early laboratory values after liver transplantation are associated with anastomotic biliary strictures

• Fasullo M
• Kandakatla P
• Amerinasab R
• Kohli DR
• Shah T
• Patel S
• Bhati C
• Bouhaidar D
• Siddiqui MS
• Vachhani R

• KMID: 2526835
• DOI: http://doi.org/10.14701/ahbps.21-103

Abstract

Backgrounds/Aims
The aim of this study was to evaluate longitudinal changes of post-liver transplantation (LT) biliary anatomy and to assess the association of increased laboratory values after LT with the development of post-LT anastomotic biliary stricture (ABS).
Methods
Adult deceased donor LT recipients from 2008 and 2019 were evaluated. ABS was defined after blinded review of endoscopic cholangiograms. Controls were patients who underwent LT for hepatocellular carcinoma who did not have any clinical or biochemical concerns for ABS.
Results
Of 534 patients who underwent LT, 57 patients had ABS and 57 patients served as controls. On MRI, ABS patients had a narrower anastomosis (2.47 ± 1.32 mm vs. 3.38 ± 1.05 mm; p < 0.01) and wider bile duct at 1-cm proximal to the anastomosis (6.73 ± 2.45 mm vs. 5.66 ± 1.95 mm; p = 0.01) than controls. Association between labs at day 7 and ABS formation was as follows: aspartate aminotransferase hazard ratio (HR): 1.014; 95% confidence interval (CI): 1.008–1.020, p = 0.001; total bilirubin HR: 1.292, 95% CI: 1.100–1.517, p = 0.002; and conjugated bilirubin HR: 1.467, 95% CI: 1.216–1.768, p = 0.001. Corresponding analysis results for day 28 were alanine aminotransferase HR: 1.004, 95% CI: 1.002–1.006, p = 0.001; alkaline phosphatase HR: 1.005, 95% CI: 1.003–1.007, p = 0.001; total bilirubin HR: 1.233, 95% CI: 1.110–1.369, p = 0.001; and conjugated bilirubin HR: 1.272, 95% CI: 1.126–1.437, p = 0.001.
Conclusions
Elevation of laboratory values early after LT is associated with ABS formation.

Keyword

Liver transplantation; Common bile duct; Cholangiopancreatography; endoscopic retrograde; Bile ducts; Magnetic resonance imaging

Figure

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  Fig. 1 Normal anatomical changes in measurements of biliary anastomosis length (A), common bile duct at 1 cm distal to the anastomosis (B), common bile duct size at 1 cm proximal to the anastomosis (C), and the caliber of bile duct anastomosis (D) over 18 months post-liver transplant.

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  Fig. 2 Comparison of biliary morphology between patients with post liver transplant anastomotic biliary strictures and controls. The length of anastomosis, diameter of the anastomosis, and proximal and distal biliary segments were compared. Anatomoy for the subject group was recorded at the time of presentation and diagnoses of anastomotic biliary stricture while that for the control group was recorded at 6-month post-transplant.

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