To Stent or Not to Stent: Is It a Question? Routine Trans-Cystic Stenting Does Not Reduce Biliary Anastomotic Strictures Post-Liver Transplantation.

Background: We aim to compare the incidence and risk factors for biliary anastomotic stricture (BAS) in patients undergoing orthotopic liver transplant (OLT) with and without transcystic externalised trans-anastomotic biliary stenting.

Methods: A retrospective analysis was performed of a prospective database focused on 836 cadaveric OLT. Primary outcome measures were the incidence of BAS and risk factors related to its development.

Results: Duct-to-duct anastomosis was the most commonly performed biliary reconstruction (90.5%). Transcystic externalised trans-anastomotic biliary stenting was performed in 420 patients (62.0%), being mostly used in patients having a duct-to-duct anastomosis (63.6%). BAS was seen in 222 (32.8%) patients, with a median time to diagnosis of 145.5 days (IQR 50.3-370.5). BAS was higher in patients with a duct-to-duct reconstruction when compared to those having a bilio-enteric reconstruction (34.3% vs. 18.7%, p = 0.02). The prevalence of BAS was not significantly different between patients who were stented and those who were not (34.5% vs. 30.0% respectively, p = 0.25). Multivariable analysis showed that older donor age, transplants performed earlier in the study period, higher MELD score, and type of biliary reconstruction (duct-to-duct) were independently associated with a higher risk of BAS.

Conclusion: Transcystic externalised biliary anastomotic stenting is not associated with a reduced biliary stricture incidence in OLT.