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A New Biodegradable Stent to Improve the Management of Biliary Strictures in Pediatric Split Liver Transplantation
Paolo Marra1,2, Francesco Saverio Carbone3,4, Ludovico Dulcetta3,4
1Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy. pmarra@asst-pg23.it.
Insights
A new biodegradable biliary stent shows promise for managing post-liver transplant cholestasis in pediatric patients. This innovative approach may offer a better alternative to long-term drainage for split liver transplantation (SLT) complications.
Area of Science:
- Hepatobiliary Surgery
- Pediatric Gastroenterology
- Biomaterials Science
Background:
- Benign biliary strictures are a common complication after pediatric split liver transplantation (SLT), impacting graft survival.
- Current management strategies like bilioplasty and internal-external biliary drainage (IEBD) lack universal consensus.
- Effective management of post-SLT biliary strictures is crucial for improving outcomes in pediatric liver recipients.
Purpose of the Study:
- To evaluate the preliminary experience with a novel biodegradable biliary stent for managing post-SLT benign biliary strictures.
- To assess the safety and efficacy of this new stent in pediatric liver transplant recipients.
- To explore potential benefits over existing treatment modalities for biliary complications.
Main Methods:
- Percutaneous transhepatic implantation of a 10F helical-shaped biodegradable biliary stent was performed in pediatric SLT patients.
- The procedure was combined with standard bilioplasty and internal-external biliary drainage (IEBD).
- The study included six pediatric patients between September 2020 and April 2021, with a median follow-up of 271 days.
Main Results:
- No complications or clinical cholestasis were observed in the six pediatric patients during the follow-up period.
- One instance of stent dislodgement was reported.
- The biodegradable stent demonstrated feasibility and was well-tolerated in this small cohort.
Conclusions:
- The biodegradable biliary stent shows potential as a management option for post-SLT cholestasis in pediatric patients.
- Technical considerations during implantation are important for successful outcomes.
- This device may offer a way to prolong biliary drainage and potentially reduce the need for long-term IEBD, improving patient comfort.
Purpose:
Cholestasis due to benign biliary strictures is the most common biliary complication after pediatric split liver transplantation (SLT), decreasing graft survival, but consensus about its management lacks. Percutaneous transhepatic cholangiography, bilioplasty and internal-external biliary drainage (IEBD) are standard treatments. The aim of this report is to present the preliminary experience with a new biodegradable biliary stent in the management of post-SLT biliary strictures.
Materials And Methods:
Between September 2020 and April 2021, SLT patients with a single anastomotic benign biliary stricture underwent percutaneous transhepatic implantation of an innovative 10F helical-shaped biodegradable biliary stent, featuring a slow degradation profile, in addition to the standard treatment with bilioplasty and IEBD. The device is unique and the first to be CE-marked for the use in this indication.
Results:
Six pediatric patients (4 males; median age 8.6 years, interquartile range 3.7 years) underwent percutaneous stent implantation, without complications nor clinical cholestasis during a median follow-up of 271 days (IQR 120.25). Stent dislodgement occurred in one case.
Conclusion:
Preliminary data suggest that implantation of a new biodegradable biliary stent may be considered in the management of post-SLT cholestasis in pediatric patients. Some technical tips are useful during implantation. This device may prolong biliary drainage, potentially relieving the discomfort of long-term IEBD.
