title: Outcomes and risk factors for failure of radiologic treatment of biliary strictures in pediatric liver transplantation recipients.
abstract: Posttransplantation biliary strictures occur in 5-34% of the pediatric liver transplant patients and are conventionally managed by interventional radiological techniques. The aim of this manuscript is to assess the outcomes of patients with biliary strictures treated by percutaneous dilatation at our institution. Included in the study were 35 children with posttransplant biliary strictures that were treated with percutaneous dilatation and stenting. Initial dilation and biliary stent placement was accomplished in all patients without complications requiring surgical intervention. Recurrent strictures developed in 23 (66%) of 35 patients. The recurrence rate was 45% for anastomotic strictures, 90% for intrahepatic strictures, and 100% for those with both an anastomotic and intrahepatic component. Seven patients required revision of the choledochojejunostomy, 5 of them with a successful outcome and 2 requiring retransplant. Five patients were treated with retransplantation without surgical revision. Patients with an intrahepatic or a "combined" stricture were less likely to have a successful outcome after radiologic treatment. In conclusion, the radiological treatment of biliary strictures with balloon dilation and stenting can be performed successfully with minimal complications avoiding the need for surgical correction in many cases.
authors.affiliation: Department of Pediatrics, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL 60614, USA.
authors.forename: Bhanu
authors.initials: B
authors.lastname: Sunku
authors.forename: Paolo R O
authors.initials: PR
authors.lastname: Salvalaggio
authors.forename: James S
authors.initials: JS
authors.lastname: Donaldson
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Rigsby
authors.forename: Katie
authors.initials: K
authors.lastname: Neighbors
authors.forename: Riccardo A
authors.initials: RA
authors.lastname: Superina
authors.forename: Estella M
authors.initials: EM
authors.lastname: Alonso
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D015641:Radiography, Interventional; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D017211:Treatment Failure