Role of Biliary Stress Manometry after Biliary Stricture Dilation in Living Donor Liver Transplant Recipients

Purpose

To report on the use of biliary manometry for determining treatment completion in living donor liver transplant recipients.

Materials and Methods

Twenty of 85 patients (24%) who underwent living donor liver transplantation developed postoperative anastomotic biliary strictures. Fifteen patients underwent transhepatic biliary drainage and percutaneous dilation. In 10 patients, biliary stress manometry was used to assess treatment adequacy after a mean of 2.5 dilation sessions occurring during a mean period of 62 days (range, 5–55 days). An intrabiliary pressure of less than 20-cm H₂O after an escalating intrabiliary infusion to 1,200 mL per hour for 3 minutes was defined as the success threshold (in lieu of a capped external catheter “clinical trial”).

Results

There were no complications during the infusion study. In all 10 patients in whom manometry was successful, biliary catheters were removed. One patient (who underwent manometry and catheter removal after only one dilation session) required repeat intubation 7 weeks later. The remaining nine patients (90%) remained free of evidence of biliary obstruction at a mean of 8.4 months. With Kaplan-Meier survival analysis, the probability of biliary patency at 3, 6, and 12 months was 90%.

Conclusions

This biliary stress manometry protocol offers a promising alternative to the catheter “clinical trial” for determining endpoints for multisession anastomotic biliary stricture dilation in living donor transplant recipients.