AUTHOR=Georges Pauline , Clerc Clémentine , Turco Célia , Di Martino Vincent , Paquette Brice , Minello Anne , Calame Paul , Magnin Joséphine , Vuitton Lucine , Weil-Verhoeven Delphine , Lakkis Zaher , Vanlemmens Claire , Latournerie Marianne , Heyd Bruno , Doussot Alexandre 

TITLE=Post-Transplantation Cytomegalovirus Infection Interplays With the Development of Anastomotic Biliary Strictures After Liver Transplantation

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10292

DOI=10.3389/ti.2022.10292

ISSN=1432-2277

ABSTRACT=Background: Anastomotic biliary stricture (ABS) remains the most frequent complication after liver transplantation (LT). This study aimed to identify new anastomotic biliary stricture risk factors, with a specific focus on postoperative events. Additionally, ABS management and impact on patient and graft survival were assessed.
Methods: All consecutive patients who underwent LT with duct-to-duct anastomosis between 2010 and 2019 were included. All patients who died within 90 days after LT due to non-ABS-related causes were excluded. 
Results: Among 240 included patients, 65 (27.1%) developed anastomotic biliary stricture. Median follow-up was 49 months (7-126). Median time to ABS was 142 days (range, 13-1265). Upon multivariable analysis, donor BMI (OR=0.509, p=0.037), post-LT CMV primoinfection (OR=5.244, p<0.001) or reactivation (OR=2.421, p=0.015) and the occurrence of post-LT anastomotic biliary fistula (OR=2.691, p=0.021) were associated with ABS. Anastomotic technical difficulty did not independently impact the risk of ABS (OR=1.923, p=0.051). First-line ABS treatment was systematically endoscopic (100%), and required a median of 2 (range, 1-11) procedures per patient. Twelve patients (18.5%) eventually developed ABS recurrence, of which nine were managed endoscopically, two percutaneously and one surgically. Repeat LT was not required in patients developing ABS. The occurrence of ABS was not associated with overall patient survival (p=0.912) nor graft survival (p=0.521).
Conclusion:  The risk of developing ABS after LT seems driven by the occurrence of postoperative events such as CMV infection especially primoinfection, and anastomotic biliary fistula. The association of ABS with post-transplant CMV infection and the role of CMV prophylaxis warrants further investigations.