Percutaneous interventional management of biliary complications after pediatric liver transplantation: A 16‐year single‐institution experience

Prajapati, Hasmukh J.; Kavali, P.

doi:10.1111/petr.12837

Cited by 8 publications

(6 citation statements)

References 19 publications

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“…In the pediatric population, the existing pool of data on pediatric biliary complications is relatively small and heterogeneous. Different techniques and treatment algorithms are used at different centers, and encompass endoscopic, percutaneous, and surgical routes and are also likely subject to variability in their transplant populations 6,10,11,14–16,26,31,33,35–38,41–66 . A brief summary of the existing literature regarding the outcomes of pediatric patients who underwent non‐surgical biliary complication management after liver transplant is provided in Table 6.…”

Section: Discussionmentioning

confidence: 99%

“…Existing data on outcomes of non‐operative management of biliary complications following LT in pediatric patients, however, are limited and heterogeneous 10,26,31–38 . The purpose of this study was to evaluate the ability of non‐operative endoscopic and percutaneous interventions to treat pediatric LT recipients with biliary strictures and/or leaks, and to evaluate factors that predict failure of these minimally invasive techniques.…”

Section: Introductionmentioning

confidence: 99%

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Non‐operative management of biliary complications after Liver Transplantation in pediatric patients: A 30‐year experience

Lee

Lehrman

Perito

et al. 2021

Pediatric Transplantation

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Background To evaluate the efficacy of percutaneous and endoscopic therapeutic interventions for biliary strictures and leaks following LT in children. Methods Retrospective analysis of 49 consecutive pediatric liver transplant recipients (27 girls, 22 boys, mean age at transplant 3.9 years) treated at our institution from 1989 to 2019 for biliary leak and/or biliary stricture was performed. Minimally invasive approach was considered clinically successful if it resulted in patency of the narrowed biliary segment and/or correction of the biliary leak. Results Forty‐two patients had a stricture at the biliary anastomosis; seven had a biliary leak. After an average 13.8 years of follow‐up, long‐term clinical success with minimally invasive treatment (no surgery or re‐transplant) was achieved for 24 children (57%) with biliary stricture and 4 (57%) with biliary leaks. Eight patients required re‐transplant; however, only one was due to failure of both percutaneous and surgical management. For biliary strictures, failure of non‐surgical management was associated with younger age at stricture diagnosis (p < .02). Conclusions Percutaneous and endoscopic management of biliary strictures and leaks after LT in children is associated with a durable result in >50% of children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non‐operative management of biliary complications after Liver Transplantation in pediatric patients: A 30‐year experience

Lee

Lehrman

Perito

et al. 2021

Pediatric Transplantation

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“…Применение исключительно баллонной дилатации без длительного формирования соустья на каркасе в виде наружно-внутреннего дренажа характеризуется более высокой частотой рестенозов [13][14][15]. В связи с этим представленная методика позволяет разрешить стриктуру с хорошим долгосрочным эффектом.…”

Section: Discussionunclassified

Treatment of biliodigestive anastomotic strictures after transplantation of left lateral segment of the liver

Monakhov

Миронков

Voskanov

et al. 2020

RJTAO

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Many studies have shown that biliary complications after transplantation of the left lateral segment (LLS) of the liver reduce graft and recipient survival. Thus, timely correction of biliary complications, and strictures in particular, improves long-term outcomes in transplantation. Objective: to analyze our own experience in correcting biliary strictures in LLS graft transplantation. Materials and methods. From February 2014 to April 2020, 425 LLS grafts were transplanted in children. 19 (4.5%) patients were diagnosed with biliary strictures at different times after transplantation (from 0.2 to 97 months). Results. Biliary strictures were more often formed a year after transplantation (17.8 ± 23.9 months). In 14 out of the 19 patients, internal-external biliary drainage was successfully performed with phased replacement of the catheter with one that was larger in diameter (from 8.5 Fr to 14 Fr). The catheters were removed in 8 patients after completion of the treatment cycle. Restenosis was not observed during follow-up (13 ± 8.7 months) after the internal-external biliary drainage catheter had been removed. In 5 cases, antegrade passage of a guide wire through the stricture was unsuccessful. As a result, biliary reconstruction was performed in 4 (21.1%) patients and retransplantation was required in 1 (5.3%) patient. Conclusion. An antegrade minimally invasive approach can successfully eliminate biliary strictures in most children after liver LLS graft transplantation. The proposed technique is effective and safe.

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“…As biliary atresia is the most common original disease, RY hepaticojejunostomy is a standard procedure for biliary reconstruction in pediatric liver transplantation, and biliary strictures are the most frequent biliary complication, with an incidence of 10-15%. [6][7][8][9][10][11] Therapeutic options for biliary strictures include surgical and nonsurgical interventions. Common nonsurgical interventions are balloon dilatation and stent placement using the endoscopic approach or PTB approach.…”

Section: Introductionmentioning

confidence: 99%

“…However, biliary complications remain the Achilles heel of liver transplantation and can lead to significant morbidity and mortality. As biliary atresia is the most common original disease, RY hepaticojejunostomy is a standard procedure for biliary reconstruction in pediatric liver transplantation, and biliary strictures are the most frequent biliary complication, with an incidence of 10–15% 6‐11 …”

Section: Introductionmentioning

confidence: 99%

Novel technique for recanalization of severe hepaticojejunal obstruction using a transseptal needle in a pediatric liver transplant recipient

Sasaki

Ota

Miyagi

et al. 2021

Pediatric Transplantation

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Background Endoscopic and PTB interventions are common nonsurgical interventions for biliary anastomotic strictures that occur after liver transplantation. When these nonsurgical interventions fail, surgical re‐anastomosis is considered; however, this is quite invasive and can cause additional injury that may lead to graft loss. We report a case in which conventional nonsurgical interventions failed, but a new method that involve the use of a transseptal needle—a device to create a transseptal left‐heart access during cardiac catheter interventions—was successfully used in recanalization of the hepaticojejunal anastomotic obstruction. Case A 21‐year‐old man, who had received living‐donor liver transplantation for biliary atresia at the age of 23 months presented with recurrent cholangitis and liver dysfunction due to a biliary anastomotic stricture of the hepaticojejunostomy. Therapeutic interventions for biliary stricture, including the PTB approach, double‐balloon enteroscopic approach, and rendezvous approach failed. We then performed needle puncture of the anastomotic obstruction using a transseptal needle and succeeded in recanalizing the complete anastomotic obstruction. To perform the procedures safely, we evaluated the organ and needle positions using biplane fluoroscopy and placed a balloon in the afferent jejunal limb as a target for puncture. The 12 Fr catheter via the biliary route was removed 7 months after the procedure, without using a catheter, there was no recurrent stricture or cholangitis for 26 months. Conclusion Using a transseptal needle to manage hepaticojejunal anastomotic obstruction can reduce the number of patients who need surgical re‐anastomosis.

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Percutaneous interventional management of biliary complications after pediatric liver transplantation: A 16‐year single‐institution experience

Cited by 8 publications

References 19 publications

Non‐operative management of biliary complications after Liver Transplantation in pediatric patients: A 30‐year experience

Non‐operative management of biliary complications after Liver Transplantation in pediatric patients: A 30‐year experience

Treatment of biliodigestive anastomotic strictures after transplantation of left lateral segment of the liver

Novel technique for recanalization of severe hepaticojejunal obstruction using a transseptal needle in a pediatric liver transplant recipient

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