Biliary Strictures Are Associated With Both Early and Late Hepatic Artery Stenosis

Angus Hann; Rashmi Seth; Hynek Mergental; Hermien Hartog; Mohammad Alzoubi; Arie Stangou; Omar El-Sherif; James Ferguson; Keith Roberts; Paolo Muiesan; Ye Oo; John R Issac; Darius Mirza; M Thamara P R Perera

doi:10.1097/TXD.0000000000001092

Biliary Strictures Are Associated With Both Early and Late Hepatic Artery Stenosis

Transplant Direct. 2020 Dec 15;7(1):e643. doi: 10.1097/TXD.0000000000001092. eCollection 2021 Jan.

Authors

Angus Hann^{1

2}, Rashmi Seth^{1

3}, Hynek Mergental¹, Hermien Hartog¹, Mohammad Alzoubi^{1

4}, Arie Stangou¹, Omar El-Sherif¹, James Ferguson¹, Keith Roberts¹, Paolo Muiesan¹, Ye Oo^{1

3}, John R Issac¹, Darius Mirza¹, M Thamara P R Perera¹

Affiliations

¹ Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.
² Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom.
³ The Pfleger Liver Institute, The Dumont-UCLA Transplant and Liver Cancer Centres, Ronald Reagan UCLA Medical Centre, Los Angeles, CA.
⁴ Department of General Surgery, Jordan University Hospital, The University of Jordan.

Abstract

Background: Hepatic artery stenosis (HAS) following liver transplantation results in hypoperfusion and ischemic damage to the biliary tree. This study aimed to investigate how vascular intervention, liver function test derangement, and time point of HAS onset influence biliary complications.

Methods: A single-center retrospective study of adult patients that underwent primary liver transplantation. Patients were grouped according to the presence or absence of HAS and then into early (≤90 d) or late (>90 d) subgroups. Biliary complications comprised anastomotic (AS) or non ASs (NASs).

Results: Computed tomography angiography confirmed HAS was present in 39 of 1232 patients (3.2%). This occurred at ≤90 and >90 days in 20 (1.6%) and 19 (1.5%), respectively. The incidence of biliary strictures (BSs) in the group with HAS was higher than the group without (13/39; 33% versus 85/1193; 7.1%, P = 0.01). BS occurred in 8/20 (40.0%) and 5/19 (26.3%) of the early and late groups, respectively. The need for biliary intervention increased if any liver function test result was ≥3× upper limit of normal (P = 0.019).

Conclusions: BS occurs at a significantly higher rate in the presence of HAS. Onset of HAS at ≤90 or ≥90 days can both be associated with morbidity. Significant liver function test derangement at HAS diagnosis indicates a higher likelihood of biliary intervention for strictures.