Outcomes and risk factors for failure of radiologic treatment of biliary strictures in pediatric liver transplantation recipients

Abstract

Posttransplantation biliary strictures occur in 5-34% of the pediatric liver transplant patients and are conventionally managed by interventional radiological techniques. The aim of this manuscript is to assess the outcomes of patients with biliary strictures treated by percutaneous dilatation at our institution. Included in the study were 35 children with posttransplant biliary strictures that were treated with percutaneous dilatation and stenting. Initial dilation and biliary stent placement was accomplished in all patients without complications requiring surgical intervention. Recurrent strictures developed in 23 (66%) of 35 patients. The recurrence rate was 45% for anastomotic strictures, 90% for intrahepatic strictures, and 100% for those with both an anastomotic and intrahepatic component. Seven patients required revision of the choledochojejunostomy, 5 of them with a successful outcome and 2 requiring retransplant. Five patients were treated with retransplantation without surgical revision. Patients with an intrahepatic or a "combined" stricture were less likely to have a successful outcome after radiologic treatment.In conclusion, the radiological treatment of biliary strictures with balloon dilation and stenting can be performed successfully with minimal complications avoiding the need for surgical correction in many cases. Liver Transpl 12: 821-826, 2006.

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

“…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).…”

“…Although this is a retrospective single-institution study, we had a mean follow-up of 2,364 days (79 months) longer than many other studies (Sunku et al 54 months [7]; 13 months in Miraglia et al [1] and 24 months in Brun et al [8]). …”

Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation

“…Therefore, comparisons with nonsurgical classifications used to define morbidity and mortality (eg, the Society of Cardiovascular and Interventional Radiology guidelines regarding major and minor complications) must be interpreted with caution. A literature review of singlecenter reports illustrated that recurrence rates after percutaneous treatments for anastomotic BCs after pediatric LT varied from 0% to 66% 18,20,[22][23][24][25][26][27] (see Table 8). The recurrence rate in this series of 1-stage surgically treated anastomotic BCs was 20% with a mean follow-up of 92 months (range 5 1-210 months).…”

Interventional procedures for biliary drainage with bilioplasty in paediatric patients: dosimetric aspects

“…Treatment for biliary complications, such as strictures of the biliodigestive anastomosis or lithiasis, by percutaneous biliary drainage and bilioplasty or by lithotripsy is successful in most cases, allowing resolution without surgical revision or repeat transplantation [3,4]. The use of interventional procedures in children who have undergone orthotopic liver transplantation (OLT) allows a safe and minimally invasive approach to many postoperative complications and spares the patients further surgical procedures [5,6]. Percutaneous biliary drainage, as well as permitting the performance of direct cholangiography, allows drainage and saline lavage of the bile duct and is the first step in subsequent treatment with bilioplasty and lithotripsy.…”

“…[3,4]. Il ricorso a procedure interventistiche in pazienti pediatrici sottoposti a trapianto di fegato (OLT, Orthotopic Liver Transplant) consente di affrontare in modo sicuro e poco invasivo le molte complicanze post-chirurgiche, evitando ai pazienti ulteriori interventi chirurgici [5,6]. Il drenaggio biliare percutaneo, oltre a consentire l'esecuzione di un colangiogramma diretto, consente il drenaggio della bile, l'esecuzione di lavaggi con soluzione fisiologica ed è il primo tempo per il successivo trattamento con bilioplastica e litotripsia.…”