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Percutaneous transhepatic cholangiography and drainage for biliary strictures after pediatric liver transplantation
Jonathan Seisenbacher1, Anna M Kavallar1, Christoph Mayerhofer1
1Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria.
Insights
Percutaneous transhepatic cholangiography and drainage (PTCD) effectively treats biliary strictures after pediatric liver transplantation. Drainage duration does not influence treatment success, recurrence, or complications, but more research is needed.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Medicine
- Interventional Radiology
Background:
- Biliary strictures (BS) are a common complication following pediatric liver transplantation (pLT).
- Optimal management strategies for BS after pLT are not well-established.
- Percutaneous transhepatic cholangiography and drainage (PTCD) is a potential treatment modality.
Purpose of the Study:
- To systematically evaluate the efficacy and safety of PTCD for treating biliary strictures in pediatric liver transplant recipients.
- To analyze the impact of drainage duration on PTCD outcomes.
- To identify risk factors influencing treatment success.
Main Methods:
- A systematic literature search was conducted on online databases for studies from 2000 to 2024.
- Meta-regression analysis was employed to assess efficacy, safety, and the influence of risk factors.
- Twenty-seven observational studies involving 802 patients were included.
Main Results:
- The incidence of BS after pLT was 13.1%.
- PTCD achieved stricture resolution in 78.3% of patients.
- Drainage duration, recurrence rates (16.0%), and complication rates (9.9%) were not significantly affected by drainage duration.
Conclusions:
- PTCD is an effective treatment for biliary strictures post-pediatric liver transplantation.
- Drainage duration does not appear to impact efficacy, recurrence, or complication rates.
- Further randomized controlled trials are required to optimize PTCD treatment protocols.
Objectives:
Biliary strictures (BS) remain frequent after pediatric liver transplantation (pLT) and best management practices are still lacking. This study systematically assesses efficacy of stricture treatment by percutaneous transhepatic cholangiography and drainage (PTCD).
Methods:
Online databases were searched for studies on PTCD treatment of BS after pLT from the year 2000 to 2024. Efficacy and safety profile of PTCD were analyzed. Influence of various risk factors on outcome parameters was compared by meta-regression.
Results:
Twenty-seven observational studies with 802 patients undergoing PTCD for BS met the inclusion criteria. Incidence of BS was 13.1% (95% confidence interval [CI]: 10.3-16.1) in 6543 patients reported who underwent pLT between 1989 and 2020. Overall efficacy of PTCD to achieve stricture resolution was 78.3% (95% CI: 66.5-80.4). Drainage duration longer or shorter than 109.1 days did not impact on achievement of resolution with efficacies of 76.5% (95% CI: 65.4-86.2) in short versus 75.1% (95% CI: 61.9-86.5, p = 0.87) in long drainage. Overall recurrence rate after stricture resolution was 16.0% (95% CI: 7.5-26.3). Drainage duration longer or shorter than 109.1 days did not affect recurrence rate which was 17.4% (95% CI: 3.3-37.3) in short versus 20.9% (95% CI: 14.0-28.5, p = 0.68) in long drainage duration. Overall rate of procedure-related complications was 9.9% (95% CI: 2.6-20.0, p = 0.99) and was not influenced by drainage duration.
Conclusions:
PTCD is efficient to treat BS after pLT. Drainage time does not impact efficacy, recurrence rate, and complication rate. Randomized trials are necessary to determine the best treatment protocol concerning drainage duration and intervals between interventions.
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