In living donor liver transplantation (LDLT), anastomotic biliary stricture is a serious and refractory complication. In this study, we reviewed the transition of post-LDLT anastomotic biliary strictures and evaluated long-term outcomes of stent placement inside the bile duct, which is referred to as an “inside-stent.” Of 805 consecutive adult LDLT recipients in our institution (2000-2018), we reviewed 639 patients with duct-to-duct biliary reconstruction and analyzed chronological changes of post-LDLT biliary strictures. Moreover, we focused on the year 2006 when various surgical modifications were introduced and compared the details of post-LDLT biliary strictures before and after 2006, especially focusing on the long-term outcome of inside-stent placement. The proportion of left lobe grafts had increased from 1.8% before 2005 to 39.3% after 2006 (P < 0.001) to maximize the living donor safety. Overall, post-LDLT anastomotic biliary strictures occurred in 21.3% of the patients with a median follow-up period of 106.1 months, which was decreased from 32.6% before 2005 to 12.8% after 2006 (P < 0.001). Anastomotic biliary strictures were less frequent in patients with left lobe grafts than with right lobe grafts (9.4% versus 25.4%; P < 0.001). The overall technical success rate of inside-stent placement was 82.4%, with an improvement from 75.3% before 2005 up to 95.7% after 2006 (P < 0.01). Furthermore, the stricture resolution rate remained high at approximately 90% throughout the observation period. Increased use of left lobe grafts with several surgical modifications significantly reduced post-LDLT anastomotic biliary strictures, leading to favorable long-term outcomes of inside-stent placements for this condition.

中文翻译：

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活体肝移植后胆管内支架置入治疗胆管狭窄的长期结果

在活体肝移植 (LDLT) 中，吻合口胆道狭窄是一种严重且难治的并发症。在这项研究中，我们回顾了 LDLT 后吻合口胆道狭窄的转变，并评估了胆管内支架置入（称为“支架内”）的长期结果。在我们机构（2000 年至 2018 年）连续 805 名成人 LDLT 接受者中，我们回顾了 639 名接受胆管间胆道重建的患者，并分析了 LDLT 后胆道狭窄的时间顺序变化。此外，我们着眼于 2006 年，当时引入了各种手术修改，并比较了 2006 年前后 LDLT 后胆道狭窄的细节，特别关注了支架内放置的长期结果。左叶移植的比例从2005年之前的1.8%增加到39。P  < 0.001) 以最大限度地提高活体供体的安全性。总体而言，21.3% 的患者发生 LDLT 后吻合口胆道狭窄，中位随访时间为 106.1 个月，从 2005 年之前的 32.6% 下降到 2006 年之后的 12.8%（P < 0.001 ）  。左叶移植患者的吻合口胆管狭窄发生率低于右叶移植患者（9.4% 对 25.4%；P  < 0.001）。支架内置入总体技术成功率为82.4%，由2005年前的75.3%提高到2006年后的95.7%（P < 0.01)。此外，在整个观察期间，狭窄消退率保持在约 90% 的高水平。增加左叶移植物的使用并进行多种手术修改可显着减少 LDLT 后吻合口胆道狭窄，从而为这种情况的内部支架置入带来有利的长期结果。