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Percutaneous management of biliary strictures after pediatric liver transplantation
Roberto Miraglia1, Luigi Maruzzelli, Settimo Caruso
1Department of Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Via Tricomi 1, 90127, Palermo, Italy. rmiraglia@ismett.edu
Insights
Biliary strictures (BSs) are a common issue after pediatric liver transplants. Percutaneous radiological treatments, including stenting and bilioplasty, offer a safe and effective management option, often avoiding surgery.
Area of Science:
- Hepatology
- Interventional Radiology
- Pediatric Surgery
Background:
- Biliary strictures (BSs) represent a significant complication following pediatric liver transplantation.
- Effective management strategies are crucial to improve patient outcomes and graft survival.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous radiological interventions for managing biliary strictures in pediatric liver transplant recipients.
- To assess the recurrence rates and long-term outcomes of these minimally invasive procedures.
Main Methods:
- Analysis of 27 pediatric patients diagnosed with BS post-liver transplantation.
- All patients underwent percutaneous transhepatic cholangiography, biliary catheter placement, and bilioplasty.
- Percutaneous balloon dilatation was the primary treatment for stenosis, with repeat procedures as necessary.
Main Results:
- Percutaneous balloon dilatation resolved stenosis in 20 out of 27 patients, with a mean of 4.1 dilatations per patient.
- No major complications were reported.
- Symptom-free status for BS was achieved in all 20 treated patients at a mean follow-up of 13 months, with low recurrence rates across one to three treatment courses.
Conclusions:
- Radiological percutaneous treatment is a safe and effective approach for managing biliary strictures after pediatric liver transplantation.
- This minimally invasive strategy can successfully avoid surgical revision of the anastomosis in the majority of cases.
Abstract:
We analyze our experience with the management of biliary strictures (BSs) in 27 pediatric patients who underwent liver transplantation with the diagnosis of BS. Mean recipient age was 38 months (range, 2.5-182 months). In all patients percutaneous transhepatic cholangiography, biliary catheter placement, and bilioplasty were performed. In 20 patients the stenoses were judged resolved by percutaneous balloon dilatation and the catheters removed. Mean number of balloon dilatations performed was 4.1 (range, 3-6). No major complications occurred. All 20 patients are symptom-free with respect to BS at a mean follow-up of 13 months (range, 2-46 months). In 15 of 20 patients (75%) one course of percutaneous stenting and bilioplasty was performed, with no evidence of recurrence of BS at a mean follow-up of 15 months (range, 2-46 months). In 4 of 20 patients (20%) two courses of percutaneous stenting and bilioplasty were performed; the mean time to recurrence was 9.8 months (range, 2.4-24 months). There was no evidence of recurrence of BS at a mean follow-up of 12 months (range, 2-16 months). In 1 of 20 patients (5%) three courses of percutaneous stenting and bilioplasty were performed; there was no evidence of recurrence of BS at a mean follow-up of 10 months. In conclusion, BS is a major problem following pediatric liver transplantation. Radiological percutaneous treatment is safe and effective, avoiding, in most cases, surgical revision of the anastomosis.