Experiences of liver retransplantation for postoperative diffuse biliary strictures

Objective: To investigate the feasibility and management of retransplantation for diffuse biliary strictures occurring after initial liver transplantation. Methods: The clinical data of 53 consecutive liver retransplantation patients at our hospital from January 2001 to December 2009 were collected and analyzed retrospectively. Among them, 20 (37.7%) were due to diffuse biliary strictures. Results: Diffuse biliary strictures appeared at 3-16 months after initial transplantation. The mean time was 6.3 months. The specific types included intra-hepatic diffuse biliary strictures (n=16) and multi-strictures involving both intra- & extra-hepatic biliary ducts (n=4). Retransplantation was performed after a failure of intervention or/and other comprehensive treatments. Among them, 14 were cured and 6 died from peri-operative complications including serious abdominal infection & MODS (multiple organ dysfunction syndrome) (n=3, 50%), biliary fistula (n=2, 33.3%) and hepatic artery embolism (n=1, 16.7%). These patients were followed up for a mean time of 1.8 years (range: 1-5 years). The accumulative survival rates at 1, 3 and 6 months were 80.0%, 75.0% and 70.0% respectively. Conclusions: Liver retransplantation is the ultimate treatment for diffuse biliary strictures after liver transplantation. The survival rate is associated with operative timing, surgical techniques and peri-operative management.