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Improved Outcomes from Prolonged Percutaneous Biliary Drainage in Pediatric Patients with Biliary Stenosis after
Christin Fürnstahl1, Elif Can2, Simone Hammer1
1Department of Radiology, University of Regensburg - University Medical Center Regensburg, Regensburg, Germany.
Insights
Percutaneous transhepatic biliary drainage (PTBD) for pediatric liver transplant recipients with biliary strictures shows high patency rates. Longer PTBD duration (≥5 months) significantly reduces restenosis risk and improves outcomes.
Area of Science:
- Hepatology
- Transplant Surgery
- Interventional Radiology
Background:
- Biliary complications, including strictures, are common after pediatric liver transplantation (pLT).
- Roux-en-Y hepaticojejunostomy is the standard reconstructive method.
- Percutaneous transhepatic biliary drainage (PTBD) is an intervention for managing biliary strictures.
Purpose of the Study:
- To evaluate the patency rates of PTBD in pediatric liver transplant recipients.
- To assess the outcomes of PTBD for biliary strictures.
- To identify predictors of biliary stricture recurrence after PTBD.
Main Methods:
- Retrospective analysis of 47 PTBD procedures in 40 pediatric patients post-pLT (2009-2019).
- Kaplan-Meier, log-rank, and Cox regression analyses were used to assess patency and influencing factors.
- Institutional protocols guided management, including drain upsizing every 6-8 weeks.
Main Results:
- Primary patency rates for PTBD were 89.4% at 1 year and 86.3% at 5 years.
- Restenosis occurred in 15% of patients after a median of 8.5 months.
- Longer PTBD dwell time (≥5 months) was associated with reduced recurrence risk (HR 0.52).
Conclusions:
- PTBD duration of at least 5 months is crucial for improving biliary patency and reducing restenosis risk.
- Shorter PTBD durations increase the risk of biliary stricture recurrence.
- Outcomes are influenced by PTBD duration, vascular status, bile leaks, and surgical complexity.
Purpose:
To evaluate patency rates, outcomes of percutaneous transhepatic biliary drainage (PTBD), and predictors of stenosis recurrence.
Materials And Methods:
A retrospective analysis of 47 PTBDs in 40 pediatric patients after pLT (2009-2019) was performed. Six patients underwent repeated PTBD for recurrent biliary strictures. Kaplan-Meier, log-rank, and Cox regression analyses evaluated patency and influencing factors. Management followed institutional protocols with drain upsizing every 6-8 weeks. The median age and weight were 1.8 years (interquartile range [IQR], 0.8-8.2) and 9.9 kg (IQR, 7.5-19.6), respectively.
Results:
The median interval from pLT to PTBD was 122 days (IQR, 55-626). The primary patency rates were 89.4% at 1 year and 86.3% at 5 years, with 15% restenosis after a median of 8.5 months. Repeat PTBD achieved patency rates of 100% at 1 year and 83.3% at 5 years (exploratory). Patency declined with dwell times of <5 months (P = .015), biliary leaks limited to the period before or during PTBD (post-PTBD leaks showed no association), hepaticojejunostomy revision, complex portal-vein reconstruction, and low- to moderate-grade hepatic artery stenosis. Longer dwell time reduced recurrence risk (hazard ratio, 0.52; 95% confidence interval, 0.30-0.89). Elevated alkaline phosphatase, bilirubin, gamma-glutamyl transferase, and aspartate aminotransferase levels were predictive of recurrence (P < .05).
Conclusions:
PTBD ≥5 months improved biliary patency and reduced restenosis risk. Shorter durations increased recurrence risk. Outcomes depended on PTBD duration, vascular status, bile leaks, and surgical complexity. Laboratory changes during and after therapy may have indicated recurrent stenosis.
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