Long-Term Results of Percutaneous Bilioenteric Anastomotic Stricture Treatment in Liver-Transplanted Children

Abstract

The purpose of this study was to evaluate the mid- and long-term results of percutaneous transhepatic cholangiography (PTC) and biliary drainage in children with isolated bilioenteric anastomotic stenosis (BAS) after pediatric liver transplantation. Sixty-four children underwent PTC from March 1993 to May 2008. Nineteen cholangiograms were normal; 10 showed intrahepatic biliary stenosis and BAS, and 35 showed isolated BAS. Cadaveric grafts were used in 19 and living donor grafts in 16 patients. Four patients received a whole liver, and 31 patients received a left lobe or left lateral segment. Roux-en-Y hepaticojejunostomy was performed in all patients. Indication for PTC was based on clinical, laboratory, and histopathologic findings. In patients with isolated BAS, dilation and biliary catheter placement, with changes every 2 months, were performed. Patients were separated into 4 groups according to number of treatment sessions required. The drainage catheter was removed if cholangiogram showed no significant residual stenosis and normal biliary emptying time after a minimum of 6 months. The relationship between risk factors (recipient's weight <10 kg, previous exposure to Cytomegalovirus, donor-recipient sex and weight relations, autoimmune disease as indication for transplantion, previous Kasai's surgery, use of reduced liver grafts, chronic or acute rejection occurrence) and treatment was evaluated. Before PTC, fever was observed in 46%, biliary dilation in 23%, increased bilirubin in 57%, and increased gamma-glutamyltransferase (GGT) in 100% of patients. In the group with BAS, 24 of 35 (69%) patients had histopathologic findings of cholestasis as did 9 of 19 (47%) patients in the group with normal PTC. Of the 35 patients, 23 (65.7%) needed 1 (group I), 7 needed 2 (group II), 4 needed 3 (group III), and 1 needed 4 treatment sessions (group IV). The best results were observed after 1 treatment session, and the mean duration of catheter placement and replacement was 10 months. The primary patency rate was 61.2%, and the recurrence rate was 34.3% (group I). Seven patients (7 of 35; 20%) had their stricture treated with a second treatment session (group II). The average drainage time in group II was 24 months. During a period >20 months, 4 patients (4 of 35; 11.4%) required 1 additional treatment session (group III), and 1 patient (1 of 35; 2.9%) had a catheter placed at the end of the study period (group IV). Drainage time in group I was significantly shorter than those in groups II, III, and IV (p < 0.05). There was no statistically significant relation between therapeutic response and the selected risk factors (p > 0.05). The majority of complications, such as catheter displacement and leakage, were classified as minor; however, 2 patients (5.7%) with hemobilia were noted. Complications increased according to the need for reintervention. In conclusion, balloon dilation and percutaneous drainage placement is safe and effective, and it has long-term patency for children with BAS after liver transplantation. Becau...

The role of interventional radiology in the treatment of biliary strictures after paediatric liver transplantation

“…These results are similar to those reported in the literature review of Moreira et al [4], in Burke et al [9] (where technical success varied from 67 to 85 %) and in other studies (Table 3).…”

“…It is important to note, however, that these smaller events were not considered complications in other experiences, including ours; moreover, Moreira et al [4] performed a very large number of percutaneous transhepatic cholangiography for diagnostic purposes only (Table 3).…”

“…Moreover, although many series agree on a low complication rate [1,7,8], Moreira et al review [4] reported a higher rate of minor complications: 125 minor complications were reported (in this group, however, smaller events were included such as localised skin abscesses at the catheter insertion site, dislocations or partial obstruction of the drainage) in 64 patients. It is important to note, however, that these smaller events were not considered complications in other experiences, including ours; moreover, Moreira et al [4] performed a very large number of percutaneous transhepatic cholangiography for diagnostic purposes only (Table 3).…”

Effects of selective bile duct ligation on liver parenchyma in young animals: histologic and molecular evaluations

“…However, pediatric liver transplantation presents with biliary complications in 20% to 30% of cases in the postoperative period [3]. Intra-or extrahepatic stenosis of bile ducts are frequent and may lead to secondary biliary cirrhosis and the need for retransplantation [3].…”

“…Intra-or extrahepatic stenosis of bile ducts are frequent and may lead to secondary biliary cirrhosis and the need for retransplantation [3]. It is unknown whether biliary stenosis involving isolated segments or lobes may affect the adjacent nonobstructed lobes by paracrine or endocrine means, leading to fibrosis in this parenchyma.…”