P1471 - Over Half of Liver Transplant Patients With Biliary Strictures Have Recurrence

Mark Obri, MD, Faisal Nimri, MD, Sanad Dawod, MD, Rami M. Youssef, MD, Spandana Alluri, MD, Mohamed Ramzi Almajed, MD, Johnathan Stephan, MD, Yervant Ichkhanian, MD, Andrew Watson, MD, Mazen Elatrache, MD, Robert Pompa, MD, Duyen Dang, MD, Sumit Singla, MD, Cyrus Piraka, MD, Tobias Zuchelli, MD
Henry Ford Hospital, Detroit, MI

Introduction: Biliary strictures (BS) are a known complication of liver transplantation (LT). The strictures commonly occur at the site of anastomosis but can develop elsewhere. Endoscopic retrograde cholangiography (ERC) is commonly performed to manage these strictures. The rate of stricture recurrence is variable in the literature with limited data available on predisposing factors. We aim to evaluate the rate of post-LT biliary stricture recurrence and factors influencing them.

Methods: Retrospective single-center study of patients who had a BS post-LT from 2014-2022. Patients with missing records and those who did not follow-up at least 6 months post-LT were excluded. The primary outcome was the rate of recurrence of biliary strictures after initial diagnosis and intervention via ERC. Secondary outcomes included the incidence of cholangitis, pancreatitis, and effect of race/sex on recurrence.

Results: 982 patients underwent liver transplantation during the study period. 152 patients (15.5%) developed biliary strictures. The mean age was 59.6 years and 63.2% were male. 148 (97.4%) developed an anastomotic stricture and 4 (2.6%) developed a stricture distinct from the anastomosis. A stricture was intervened upon, on average, 142.2 days (5-1864 days) after transplant. 98.0% (n=149) had 1 stricture and 1.96% (n=3) had 2 or more strictures.

Of the 152 patients who had a stricture, 57.2% of the patients (n=87) had a recurrence of the stricture that was previously identified. All 87 patients who had recurrent strictures required repeated intervention. Out of these patients, 52.8% did not have further episodes of recurrence. Of the 47.1% patients, who had a further episode of recurrence, the median time to presentation was 41 days. 2.30% (n=2) patients required surgical intervention for refractory strictures. On average, each patient with a recurrent stricture required an additional 2.02 (SD1.46) ERCs prior to resolution of the stricture. When stratified based off race and sex, there was no significant association measured with rate of recurrence. Regarding complications, 6.6% (n=10) of patients had post-procedure pancreatitis and 4.6% (n=7) had post-procedure cholangitis.

Discussion: Over half of patients had a recurrence of biliary strictures after intervention highlighting the complexity of management. There are no clear identifying factors that lead to recurrence. Further studies are needed to identify causes of these strictures as they significantly burden patients and systems alike.


Disclosures:


Mark Obri, MD, Faisal Nimri, MD, Sanad Dawod, MD, Rami M. Youssef, MD, Spandana Alluri, MD, Mohamed Ramzi Almajed, MD, Johnathan Stephan, MD, Yervant Ichkhanian, MD, Andrew Watson, MD, Mazen Elatrache, MD, Robert Pompa, MD, Duyen Dang, MD, Sumit Singla, MD, Cyrus Piraka, MD, Tobias Zuchelli, MD. P1471 - Over Half of Liver Transplant Patients With Biliary Strictures Have Recurrence, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.