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

Abstract

Purpose The aim of this study is to evaluate the safety and efficacy of percutaneous treatment of biliary strictures after paediatric liver transplantation. Materials and methods In the period between October 1999 and October 2010, a total of 92 transplants in 86 children were performed at our Liver Transplant Centre. Eighteen patients had anastomotic biliary strictures (in four cases associated with intrahepatic bile duct stenosis). Percutaneous treatment (transhepatic biliary drainage and conventional/cutting balloon dilatation) was proposed as a first approach in 13/18 patients. Strict radiation protection precautions were taken in accordance with the ALARA (as low as reasonably achievable) principle. Mean follow-up time was 2,364 days. Results Surgical correction was required in 3/13 patients; in 8/13 cases, there was complete disappearance of clinical symptoms without bile duct dilatation; in one case, an asymptomatic persistent bile duct dilatation was detected while in the other case, the liver is currently in cirrhotic degeneration (69 % clinical success including the asymptomatic patient with biliary dilatation). Two of the five patients who were initially treated with surgery required percutaneous revision (clinical success of 100 %). There were two cases of long-term restenosis and two cases of transient haemobilia.Conclusions Percutaneous procedures are safe and effective therapeutic options for the treatment of biliary strictures after paediatric liver transplantation.

Biliary strictures complicating liver transplantation in pediatric patients: Experience in a South American transplant center

“…The techniques used seem to be similar among different series reported, with a high primary success rate ranging from 77% to a 100% . The main difference among published series, however, lies in the time interval between PTC sessions and the overall drainage time (Table ).…”

“…One last variable that was not considered, and which could be of interest in future research, is the differentiation between stenosis from the anastomotic site and stenosis from another location. This differentiation may have clinical importance, as some authors report it to be related to the response to percutaneous treatment …”

“…This study does not mention the complications associated with the PTC procedure. Some of these complications include pancreatitis, bleeding, bile duct perforation, bowel perforation, and cholangitis . Complications might be associated with the worst outcomes.…”

“…Biliary complications (incidence 4%‐30%) are frequent surgical complications in children undergoing liver transplantation . They include biliary leaks, anastomotic stenosis, and nonanastomotic stenosis .…”

Long‐term outcome of percutaneous transhepatic biliary drainage for biliary strictures following pediatric liver transplantation

“…In biliary reconstruction at pediatric LT, Roux‐en‐Y hepaticojejunostomy is a standard procedure because the most common original disease is biliary atresia. Therefore, the first‐line treatment for pediatric post‐transplant biliary strictures is PTBD . However, few studies have analyzed the long‐term prognosis of PTBD for pediatric post‐transplant biliary strictures, and no consensus has yet been reached.…”