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Percutaneous Balloon Dilatation for Hepaticojejunostomy Stricture Following Paediatric Liver Transplantation:
Aldo Sebastián Oggero1, Rocío Claudia Bruballa2, Pablo Ezequiel Huespe2
1Division of Image Guided Minimally Invasive Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. asebastian.oggero@gmail.com.
Insights
Percutaneous biliary balloon dilatation (PBBD) offers long-term success for paediatric liver transplant patients with benign anastomotic strictures. A history of major complications post-transplant increases the risk of re-stricture.
Area of Science:
- Hepatobiliary Surgery
- Pediatric Gastroenterology
- Transplantation Medicine
Background:
- Benign anastomotic strictures are a complication following liver transplantation in children.
- Roux-en-Y hepaticojejunostomy is a common surgical technique used in liver transplantation.
- Effective management of these strictures is crucial for long-term graft survival and patient outcomes.
Purpose of the Study:
- To evaluate the long-term efficacy of a standardized percutaneous biliary balloon dilatation (PBBD) protocol for benign anastomotic strictures in pediatric liver transplant recipients.
- To identify risk factors associated with the recurrence of strictures after PBBD treatment.
Main Methods:
- A cohort of fourteen pediatric patients who underwent liver transplantation and developed benign anastomotic strictures of their Roux-en-Y hepaticojejunostomy were included.
- All patients were treated with a protocol of three PBBD procedures spaced 15 days apart.
- Clinical outcomes were assessed using the Terblanche classification, and primary patency rates were determined using the Kaplan-Meier method.
Main Results:
- The PBBD protocol achieved initial success in all patients, with excellent or good Terblanche grading.
- After a mean follow-up of 35.7 months, 10 patients maintained an excellent/good outcome, while 4 experienced re-stricture, predominantly within the first 19 months.
- The 1-, 3-, and 5-year patency rates were 85.7%, 70%, and 70%, respectively. A history of major post-transplant complications was a significant risk factor for re-stricture (HR 5.48).
Conclusions:
- A "Three-session" PBBD protocol demonstrates a high rate of long-term success in managing benign anastomotic strictures in pediatric liver transplant patients.
- History of major complications after liver transplantation appears to be an independent risk factor for stricture recurrence in this patient group.
- This study highlights PBBD as a valuable minimally invasive treatment option for post-transplant biliary strictures in children.
Purpose:
The aim of this study was to report the long-term results of an institutional protocol of percutaneous biliary balloon dilatation (PBBD) on paediatric patients with benign anastomotic stricture after liver transplantation. As a secondary objective, we evaluated risk factors associated with post-treatment re-stricture.
Materials And Methods:
Fourteen paediatric, post-liver transplant patients with benign anastomotic stricture of Roux-en-Y hepaticojejunostomy were included. All patients underwent the same treatment protocol of three PBBD procedures with 15-day intervals. Clinical outcome was analysed using the Terblanche classification. Primary patency rate was assessed with the Kaplan-Meier test.
Results:
All patients had an initial successful result (Terblanche grade, excellent/good) after PBBD. At the end of the follow-up time of 35.7 ± 21.1 months (CI95%, 23.5-47.9), 10 patients persisted with excellent/good grading, while the remaining 4 had re-stricture, all of the latter occurring within the first 19 months. Patency rate after percutaneous treatment at 1, 3, and 5 years were 85.7%, 70%, and 70%, respectively. History of major complication after liver transplantation was associated with 5 times higher risk of re-stricture, HR 5.48 [95% CI, 2.18-8.78], p = 0.018.
Conclusion:
In paediatric patients with benign anastomotic stricture of hepaticojejunostomy after liver transplantation, the "Three-session" percutaneous biliary balloon dilatation protocol is associated with a high rate of long-term success. In this limited series, the history of post-liver transplant major complication, defined as complications requiring a reintervention under general anaesthesia or advanced life support, seems to be an independent risk factor for stricture recurrence.
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