INTRODUCTION Biliary strictures are a common complication of donation after circulatory death (DCD) liver transplantation (LT) and require multiple endoscopic retrograde cholangiopancreatography (ERCP) procedures. Three classification systems, based on cholangiograms, have been proposed for categorizing post-LT biliary strictures. We examined the interobserver agreement for each of the three classifications. METHODS DCD LT recipients from 2012 through March 2017 undergoing ERCP for biliary strictures were included in the study. Initial cholangiograms delineating the entire biliary tree prior to endoscopic intervention were selected. One representative cholangiogram was selected from each ERCP. Five interventional endoscopists independently viewed each anonymized cholangiogram and classified the post-LT stricture according to each of the three classification systems. The Ling classification proposes four types of post-LT strictures based on their location. The Lee classification proposes four classes based on location and number of intrahepatic strictures. The binary system classifies strictures into anastomotic or non-anastomotic types. The Krippendorff's alpha reliability estimate was used to grade the strength of agreement as "poor," "fair," "moderate," "good," or "excellent" for values between 0-0.20, 0.21-0.4, 0.41-0.6, 0.61-0.08, and 0.81-1, respectively. RESULTS One hundred DCD LT recipients (age 57.07 ± 8.8 years; 71 males) were initially evaluated. Of these, 49 patients who underwent 206 ERCP procedures for biliary strictures were included in the analysis. One hundred thirty-nine cholangiograms were selected and subsequently classified by five endoscopists. Interobserver agreement for post-LT biliary strictures was 0.354 for Ling classification (fair agreement), 0.405 for Lee classification (fair agreement), and 0.421 for the binary classification (moderate agreement). The binary classification provided the least amount of detail regarding the location and number of biliary strictures. DISCUSSION The currently available classification systems for assessing post-LT biliary strictures have sub-optimal interobserver agreement. A better-designed classification system is needed for categorizing post-LT biliary strictures.

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观察者之间的协议，用于对循环死亡捐献者后的肝移植后胆道分类进行分类。

简介胆道狭窄是循环死亡（DCD）肝移植（LT）后捐赠的常见并发症，需要多次内窥镜逆行胰胆管造影（ERCP）程序。已经提出了基于胆管造影的三种分类系统，用于对LT后胆道狭窄进行分类。我们针对这三种分类检查了观察员之间的协议。方法2012年至2017年3月接受ERCP胆道狭窄的DCD LT接受者纳入研究。选择内镜介入治疗之前描绘整个胆道树的初始胆管造影照片。从每个ERCP中选择一个代表性的胆管造影照片。五名介入内镜医师独立查看每张匿名的胆管造影照片，并根据三个分类系统中的每一个对LT后狭窄进行分类。Ling分类根据其位置提出了四种类型的LT后狭窄。Lee分类法根据肝内狭窄的部位和数量提出了四个类别。二元系统将狭窄分为吻合或非吻合类型。对于0-0.20、0.21-0.4、0.41-0.6、0.61之间的值，使用Krippendorff的alpha可靠性估计将协议强度分为“差”，“中等”，“中等”，“好”或“优秀”。 -0.08和0.81-1。结果初步评估了100名DCD LT接受者（57.07±8.8岁； 71名男性）。这些，该分析包括49例因胆道狭窄而接受206次ERCP手术的患者。选择了一百三十九张胆管造影照片，随后由五名内镜医师分类。LT后胆道狭窄的观察者间协议对于Ling分类（公平协议）为0.354，对于Lee分类（公平协议）为0.405，对于二分类（中度协议）为0.421。二进制分类提供的有关胆道狭窄的部位和数量的详细信息最少。讨论目前，用于评估LT后胆道狭窄的分类系统具有次优观察者一致性。需要更好设计的分类系统来对LT后胆道狭窄进行分类。选择了一百三十九张胆管造影照片，随后由五名内镜医师分类。LT后胆道狭窄的观察者间协议对于Ling分类（公平协议）为0.354，对于Lee分类（公平协议）为0.405，对于二分类（中度协议）为0.421。二进制分类提供的有关胆道狭窄的部位和数量的详细信息最少。讨论目前，用于评估LT后胆道狭窄的分类系统具有次优观察者一致性。需要更好设计的分类系统来对LT后胆道狭窄进行分类。选择了一百三十九张胆管造影照片，随后由五名内镜医师分类。LT后胆道狭窄的观察者间协议对于Ling分类（公平协议）为0.354，对于Lee分类（公平协议）为0.405，对于二分类（中度协议）为0.421。二进制分类提供的有关胆道狭窄的部位和数量的详细信息最少。讨论目前，用于评估LT后胆道狭窄的分类系统具有次优观察者一致性。需要更好设计的分类系统来对LT后胆道狭窄进行分类。Ling分类（公平协议）为354，Lee分类（公平协议）为0.405，二元分类（中度协议）为0.421。二进制分类提供的有关胆道狭窄的部位和数量的详细信息最少。讨论目前，用于评估LT后胆道狭窄的分类系统的观察者间协议不尽人意。需要更好设计的分类系统来对LT后胆道狭窄进行分类。Ling分类（公平协议）为354，Lee分类（公平协议）为0.405，二元分类（中度协议）为0.421。二进制分类提供的有关胆道狭窄的部位和数量的详细信息最少。讨论目前，用于评估LT后胆道狭窄的分类系统具有次优观察者之间的一致性。需要更好设计的分类系统来对LT后胆道狭窄进行分类。讨论目前，用于评估LT后胆道狭窄的分类系统具有次优观察者一致性。需要更好设计的分类系统来对LT后胆道狭窄进行分类。讨论目前，用于评估LT后胆道狭窄的分类系统具有次优观察者一致性。需要更好设计的分类系统来对LT后胆道狭窄进行分类。