Long-term follow-up of percutaneous transhepatic balloon cholangioplasty in the management of biliary strictures after liver transplantation.
BACKGROUND
This study evaluated the efficacy of a protocol of initial balloon dilation for biliary strictures after liver transplantation.


METHODS
Complete records from 96 patients with biliary strictures were retrospectively reviewed. Seventy-six patients received percutaneous transhepatic balloon cholangioplasty (PTBC) after initial placement of biliary drainage (percutaneous transluminal cholangiography [PTC]) tube. In most cases, three dilations were performed with a 4 to 8 week interval between procedures. Follow-up ranged from 6 months to 10 years.


RESULTS
PTBC successfully treated strictures in 39 of 76 (51.3%) cases. Factors favoring successful PTBC included older age at transplant, shorter cold ischemic time, and single strictures. There were nine recurrent strictures after PTBC, all of which were successfully treated by nonoperative measures. The number of dilations performed affected both the likelihood of success and the long-term risk of stricture recurrence. Of the 37 PTBC failures, 14 underwent subsequent surgical revision. When both angiographic and surgical modalities were considered, treatment success was associated with first transplants, shorter cold ischemic time and operative time, and less intraoperative transfusion requirements. Factors associated with treatment failure included multiple, central hepatic duct, and intrahepatic strictures. PTC-tube independence was achieved in 51 of 76 (67%) patients using the combined approach of PTBC and surgery for PTBC failures.


CONCLUSIONS
PTBC is an effective initial modality for treating posttransplant biliary strictures. Prolonged cold ischemic and operative times and multiple or peripheral strictures predispose to treatment failure. Solitary extrahepatic strictures that fail PTBC are salvageable with surgical revision with excellent results.
Sung
Randall S
RS
Division of Transplantation, Department of Surgery, University of Michigan Health System, Ann Arbor, MI 48109-0331, USA. rssung@umich.edu
Campbell
Darrell A
DA
Rudich
Steven M
SM
Punch
Jeffrey D
JD
Shieck
Victoria L
VL
Armstrong
Joan M
JM
Ford
Elizabeth
E
Sullivan
Patricia
P
Dasika
Narasimham L
NL
Magee
John C
JC
D000328:Adult; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D002404:Catheterization; D002758:Cholangiography; D003251:Constriction, Pathologic; D015925:Cryopreservation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011309:Preservation, Biological / Q000009:adverse effects; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome