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portal vein stenting as a significant risk factor for biliary stricture in adult living donor liver transplantation

Hepatobiliary & Pancreatic Diseases International 2016年第5期15卷 480-486页

作者： Min-Ho Shin Deok-Bog Moon Sung-Gyu Lee Shin Hwang Ki-Hun Kim Chul-Soo Ahn Tae-Yong Ha Gi-Won Song Dong-Hwan Jung Gil-Chun Park Young-In Yun Wan-Jun Kim Woo-Hyoung Kang Seok-Hwan Kim Gi-Young Ko Division of Hepatobiliary Surgery and Liver Transplantation Department of SurgeryAsan Medical CenterUniversity of Ulsan College of Medicine88 0lympic-ro 43 gilSongpa-guSeoul 05505Korea Department of Radiology and Research Institute of Radiology Asan Medical CenterUniversity of Ulsan College of Medicine88 0lympic-ro 43 gilSongpa-guSeoul 05505Korea

BACKGROUND: Although perioperative portal vein (PV) stent implantation is an effective treatment for steno-occlusive disease in adult living donor liver transplantation (LDLT) re-cipients, we experienced high incidence of biliary anastomotic strictures (BAS) after PV stenting. In this study, we sought to clarify the relation between BAS and PV stenting and to suggest the possible mechanism of BAS and measures to reduce its in-cidence. METHODS: We retrospectively analyzed 44 LDLT recipients who underwent PV stent implantation across the line of PV anastomosis regardless of the location of steno-occlusion (stent group) and their matched controls (non-stented LDLT recipients, n=131). RESULTS: The incidence of BAS was higher in patients in the stent group than that in the control group (43.2% vs 17.6%, P=0.001). Cumulative 6-month and 1-, 2- and 5-year BAS rates were 31.8%, 34.1%, 41.4% and 43.2%, respectively, in the stent group and 13.0%, 13.8%, 16.1% and 17.8%, respectively, in the control group (P=0.001). Multivariate analysis revealed that PV stenting was an independent risk factor for BAS. CONCLUSIONS: Although PV stent implantation is a reliable treatment modality for steno-occlusive PV in adult LDLT recipients, innovative methods to prevent the PV stent from crossing the line of PV anastomosis may be necessary to reduce the incidence of postoperative BAS.

关键词： portal vein stenting biliary stricture living donor liver transplantation

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