Biliary strictures continue to be a significant cause of morbidity following liver transplantation (LT). Though several studies have implicated donor and recipient factors in the pathogenesis of biliary strictures (BS), the role of HCV is poorly understood. Therefore, the aim of this study is to evaluate the impact of HCV on the incidence and outcome of biliary strictures in LT recipients. Methods: Using our transplant database, we identified all adult candidates who received LT during study period (Jan 2012 – April 2014). The data collected included demographics, liver diagnosis, lab data and ERCP records. We used the chi-square test and Fisher's exact test to analyze the data. Results: During the study period, 194 patients received deceased donor LT (DDLT). There were 137 (71%) male, predominantly Caucasian (73%) with a median age of 56. The indication for LT was HCV in 43% (n= 83) and non-HCV (n= 111). During the study period, there were 58 (29.8%) with biliary strictures. Patients underwent ERCP with stent exchange and upgrade at 4 – 6 weekly intervals until stricture resolution was achieved. There was no significant difference in the incidence of biliary strictures between HCV (31.3%) versus 28.8% in non-HCV (p=0.752). However, the number of endoscopic interventions (ERCP with stent exchange/upgrade) required to achieve stricture resolution (i.e. patency) was higher in HCV group (3.5; range 1-8) compared to non-HCV (2.0; range 1-6) (p= 0.0245). The duration between initial ERCP to patency was also longer in the HCV group compared to the non-HCV group. Among the HCV group (n=83), there was no correlation between either HCV genotype or IL28b and the incidence or outcome of biliary strictures (p=ns). Conclusion: HCV has no impact on the prevalence of post-transplant biliary strictures. However, the presence of HCV influences the outcome of biliary strictures. There was a significant correlation between the severity of biliary strictures as evidenced by the number of endoscopic (ERCP) interventions required for patency and presence of HCV. This study highlights the negative impact of HCV on biliary strictures and suggests that early intervention with antiviral therapy for extrahepatic (i.e. biliary) complications might be useful irrespective of the severity of hepatitis.

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