Management of extrahepatic biliary disease after orthotopic liver transplantation

"/'425 MANAGEMENT OF EXTRAHEPATIC BILIARY DISEASE AFTER ORTHOTOPIC LIVER TRANSPLANTATION M. Sossenheimer ~, A. Slivka ~, D. Carr Locke 2, ~University of Pittsburgh Medical Center, Pittsburgh, PA, 2Brigham and Women's Hospital. Boston. MA Biliary tract complications occur after liver transplantation (OLT) in 13-34% of patients and are major causes of morbidity. Controversy exists about the management of these complications. Due to the debate about preferred biliary reconstruction as well as lack of consensus about the best management strategy for biliary complications following transplantation, a questionnaire survey of twenty-five major transplant centers was conducted to evaluate their experience with over 6000 liver transplantations as part of an American Society of Gastrointestinal Endoscopy initiative. Attention was placed on non-surgical management of biliary complications with endoscopic retrograde cbolangiopancreatography (ERCP) or percutaneous transhepatic cholangio-graphy (PTC) Results: 67% of biliary anastomoses are choledochocholedochostomy (CC) and 33% are choledochojejunostomy as Roux En-Y (CJRY). Biliary complications occurred in 16% of all liver transplantations. Approximately 40% of biliao complications were evaluated with ERCP and 41% with PTC Of those. ERCP was therapeutic in 72% and PTC in 62%. Findings included: