P0047 - Impact of Surgical Anastomotic Techniques on the Development of Post-Transplant Biliary Strictures in the Elderly

Bharat Ponnaganti, MD¹, Danial Shaikh, MD¹, Abid Javed, MD², Ambuj Kumar, MD¹, Pushpak Taunk, MD^1
1University of South Florida, Tampa, FL; ²USF Health, Tampa, FL

Introduction: Biliary complications occur in approximately 5% to 30% of orthotopic liver transplant (OLT) recipients, with biliary strictures being the most common. The data for incidence of strictures in elderly post-OLT patients is lacking. Development of biliary strictures can be immune mediated, attributed to ischemia, infection, or fibrosis from varying surgical techniques. There are two conventional surgical techniques for biliary reconstruction: End-End (EE) and Side-End (SE) anastomosis. This study aims to investigate the association between the type of surgical anastomosis during OLT and the development of biliary strictures in an elderly population.

Methods: A retrospective, single-center chart review was conducted from January 1st, 2012, to December 31st, 2021. The study included patients older than 65 at the time of OLT, who underwent either an EE or SE biliary anastomosis. Demographic data, anastomosis details, and outcomes were extracted from the EHR.

Results: 215 elderly patients who received OLT were included in the analysis. 180 patients (83.7%) underwent EE anastomosis, while 33 patients (15.3%) underwent SE anastomosis. Biliary strictures developed in 62 patients (29%). While a higher percentage of SE anastomoses (39%) developed strictures compared to EE anastomoses (27%), this difference was not significant (OR=1.79, 95% CI: 0.83 to 3.87, p=0.14). The rate of stricture formation also did not significantly differ based on difficult vs. uncomplicated anastomosis as per the operative note (27% v 29%, OR=0.92, CI: 0.24-3.59, p=0.91). A higher percentage of shorter donor bile duct patients (39%) developed strictures compared to normal donor bile ducts (28%), but again, this difference was not significant (OR=1.69, 95% CI: 0.69-4.13, p=0.25). Please refer to Table 1 for comprehensive results.

Discussion: The incidence of post-transplant biliary strictures ranges between 5-15%. Our study reveals a higher risk of biliary strictures in elderly OLT recipients compared to the general population. We found no significant association between surgical technique (EE or SE anastomosis) and biliary stricture development, as well as the presence of a short donor duct or perceived difficult anastomosis by the surgeon. In conclusion, elderly OLT recipients demonstrate an increased incidence of biliary strictures, suggesting the influence of factors beyond the type of anastomosis.




Disclosures:


Bharat Ponnaganti, MD¹, Danial Shaikh, MD¹, Abid Javed, MD², Ambuj Kumar, MD¹, Pushpak Taunk, MD¹. P0047 - Impact of Surgical Anastomotic Techniques on the Development of Post-Transplant Biliary Strictures in the Elderly, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.