SP 7.16 REACH Study- Roux-en-Y Hepaticojejunostomy Achieves Excellent Outcomes Even for Endoscopy-Refractory Post Liver Transplant Biliary Strictures: A Propensity-Matched Comparative Study
Selvakumar Naganathan, Hemant Sharma, Subash GuptaAbstract
Objectives
To assess whether Roux-en-Y hepaticojejunostomy (RYHJ) achieves excellent perioperative-outcomes (hospital length of stay, complication-rates, perioperative mortality) and long-term outcomes (graft survival, late strictures) when used as salvage therapy for complex, endoscopy-refractory biliary strictures after liver transplantation.
Design
Retrospective comparative effectiveness study using propensity score matching on key clinical variables, including patient age, gender, donor-type, and baseline liver function tests.
Setting
Single high-volume liver-transplant-center, 2014-2025. While this setting provides specialized care, generalizability to lower-volume centers may be limited.
Participants
538 liver-transplant-recipients with biliary-strictures (RYHJ n=37, ERCP/PTBD n=501). After 1:3 propensity score matching, 36 RYHJ cases were matched to 108 ERCP/PTBD controls.
Interventions
RYHJ as salvage therapy compared to ERCP/PTBD as primary management.
Main Outcomes
Hospital length of stay, perioperative mortality, and major complications. Excellent outcomes were defined as hospital stay under 35 days, perioperative mortality of 0%, and major complication rates at or below 25%. The RYHJ cohort comprised primarily salvage cases, with 75.7% having prior failed endoscopic interventions (mean 2.4±1.2 procedures). Despite complexity, RYHJ achieved excellent outcomes: hospital stay was equivalent (30.9±13.8 vs 31.7±16.9 days, p=0.793), major complication rates were identical (22.2% vs 22.2%, p=1.000), and perioperative mortality was zero in both groups. Surgical re-exploration was more frequent in RYHJ (16.7% vs 7.4%, p=0.099) but facilitated definitive management.
Limitations
Single-center retrospective design and potential unmeasured confounding. Multicenter prospective studies would enhance generalizability.
Conclusion
RYHJ achieves excellent perioperative outcomes as salvage therapy for complex, endoscopy-refractory strictures, supporting its use as a reliable surgical option.