Can Biliary Internal Stents Reduce Biliary Complications in Adult Liver Transplantation?

Y. Kwon¹, Y. S. Genyk¹, Y. Yoon²

¹Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, ²Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea, Republic of

Meeting: 2020 American Transplant Congress

Abstract number: 60

Keywords: Bile duct, Liver transplantation, Outcome, Surgical complications

Session Information

Session Name: Liver: Hepatobiliary Surgery and Liver Transplant Potpourri

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 4:27pm-4:39pm

Location: Virtual

*Purpose: Biliary complications remain a consistent cause of morbidity and mortality in liver transplant (LT) recipients and there is controversy as to whether the use of a biliary internal stent (IS) can reduce these complications. The purpose of this study was to investigate whether ISs could reduce biliary complications in LT patients.

*Methods: From November 2008 to September 2018, a retrospective cohort study was conducted on 482 patients who underwent adult deceased donor LT (DDLT) with an end-to-end choledococholedocostomy. During this period, a total of 14 surgeons performed the surgeries and the insertion of an IS was determined according to the surgeon’s preference. ISs were placed across the biliary anastomosis and passed through the ampulla. They were removed by endoscopy four to six weeks after the surgery. We compared the demographic profiles and various outcomes between the two groups (no-IS group vs. IS group) and identified the risk factors for anastomotic biliary complications.

*Results: There were 350 patients in the no-IS group and 132 patients in the IS group. Anastomotic biliary fistula (ABF) occurred in five (1.4%) patients in the no-IS group and one (0.8%) patient in the IS group (p = 0.554). Anastomotic biliary stricture (ABS) occurred in 53 (15.1%) patients in the no-IS group and 18 (13.6%) patients in the IS group (p = 0.677) There was no significant difference in the overall biliary complications between the two groups (p = 0.326). On univariate analysis, an acute rejection episode was the only risk factor for ABS (p = 0.007). There was one mortality due to a biliary complication in the no-IS group. The cause of death was an ABF-induced ruptured hepatic arterial pseudoaneurysm.

*Conclusions: The use of ISs in LT patients did not reduce the risk of anastomotic biliary complications, but more research is needed to draw definite conclusions.

To cite this abstract in AMA style:

Kwon Y, Genyk YS, Yoon Y. Can Biliary Internal Stents Reduce Biliary Complications in Adult Liver Transplantation? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/can-biliary-internal-stents-reduce-biliary-complications-in-adult-liver-transplantation/. Accessed May 11, 2025.

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