P4475 - Efficacy of Endoscopic Treatment of Post Living Donor Liver Transplant Biliary Strictures

Shaikhoon S. Mohammed, MD¹, Mohanad Awadalla, MD², Abdellatif Ismail, MD³, Hazem Abosheaishaa, MD⁴, Monzer Abdalla, MD⁵, Ayman Elawad, MD⁶, Jenson Phung, MD⁷, Khalid Ahmed, MD⁸, Kabir S. Chhabra, MD³, Andrew Canakis, DO⁹, Mohamed Abdallah, MD¹⁰, Mohammad Bilal, MD¹¹, Prabhleen Chahal, MD^12
1Emory Clinic/Emory Healthcare, Atlanta, GA; ²Beth Israel Deaconess Medical Center, Boston, MA; ³University of Maryland Medical Center, Baltimore, MD; ⁴Icahn School of Medicine at Mount Sinai, Queens, NY; ⁵Ascension Saint Francis Hospital, Evanston, IL; ⁶Massachusetts General Hospital, Boston, MA; ⁷University of Minnesota, Minneapolis, MN; ⁸University of Pennsylvania, Philadelphia, PA; ⁹University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; ¹⁰Cleveland Clinic, Cleveland, OH; ¹¹University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN; ¹²Cleveland Clinic Foundation, Cleveland, OH

Introduction: Biliary strictures are common complications in recipients of living donor liver transplant (LDLT). Endoscopic management is an established first line therapy for post-transplant biliary strictures. We conducted a systematic review and meta-analysis to evaluate the efficacy of endoscopic therapy for the management of post LDLT biliary strictures.

Methods: A systematic search was conducted across multiple databases adhering to PRISMA
guidelines. The primary outcome was defined as resolution of post LDLT biliary strictures by
endoscopic retrograde cholangiopancreatography (ERCP). Secondary outcomes included combined
ERCP and percutaneous transhepatic biliary drainage (PTBD), progression to surgery and adverse
events (AEs). Data were reported using confidence interval (CI) and heterogeneity was reported using
I² .

Results: A total of eighteen studies comprising 1142 patients were included. 16 studies were retrospective while 2 were prospective. The average age was 49 years and 73% were male. Study of origin was from Japan (6), South Korea (5), Turkey (3), India (2), United States (1) and China (1). Successful resolution of post LDLT biliary strictures by ERCP alone was achieved in 62% of cases[95% CI [50-74%]; I²:95.52%, P< 0.01] (Figure 1), stricture resolution with ERCP and PTBD was seen in 12% [95% CI [07-17%]; I²:85.16%, P< 0.01] and surgery was needed in 5% [95% CI [3-7%]; I²:67.78%, P< 0.01]. Stricture recurrence rate was 9% [95% CI [5-12%]; I²:87.44%, P< 0.01]. The overall rates of cholangitis, post-ERCP pancreatitis and perforation were 9% [95% CI [5-12%]; I²:88.39%, P< 0.01], 5% [95% CI [3-7%]; I²:79.07%, P< 0.01], and 1% [95% CI [0-1%]; I²:0%, P=1.00] respectively. Further analysis of 693 patients showed indications for LDLT were HCC in 35%, liver cirrhosis in 60%, and Fulminant hepatic failure in 5% (Figure2). Biliary stricture diagnosis was confirmed in an average of 6.8 months (1-30.1) following transplantation. The average number of ERCP procedures required to achieve stricture resolution was 4.1 (2.7-10) and the average time required to achieve resolution was 12.8 months (2.7-33).

Discussion: ERCP alone can achieve successful resolution of post-living donor liver transplant
strictures in the majority of the cases, but a sizeable number of strictures need percutaneous
interventions in combination with ERCP.



Disclosures:


Shaikhoon S. Mohammed, MD¹, Mohanad Awadalla, MD², Abdellatif Ismail, MD³, Hazem Abosheaishaa, MD⁴, Monzer Abdalla, MD⁵, Ayman Elawad, MD⁶, Jenson Phung, MD⁷, Khalid Ahmed, MD⁸, Kabir S. Chhabra, MD³, Andrew Canakis, DO⁹, Mohamed Abdallah, MD¹⁰, Mohammad Bilal, MD¹¹, Prabhleen Chahal, MD¹². P4475 - Efficacy of Endoscopic Treatment of Post Living Donor Liver Transplant Biliary Strictures, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.