Percutaneous management of biliary strictures after pediatric liver transplantation.
We analyze our experience with the management of biliary strictures (BSs) in 27 pediatric patients who underwent liver transplantation with the diagnosis of BS. Mean recipient age was 38 months (range, 2.5-182 months). In all patients percutaneous transhepatic cholangiography, biliary catheter placement, and bilioplasty were performed. In 20 patients the stenoses were judged resolved by percutaneous balloon dilatation and the catheters removed. Mean number of balloon dilatations performed was 4.1 (range, 3-6). No major complications occurred. All 20 patients are symptom-free with respect to BS at a mean follow-up of 13 months (range, 2-46 months). In 15 of 20 patients (75%) one course of percutaneous stenting and bilioplasty was performed, with no evidence of recurrence of BS at a mean follow-up of 15 months (range, 2-46 months). In 4 of 20 patients (20%) two courses of percutaneous stenting and bilioplasty were performed; the mean time to recurrence was 9.8 months (range, 2.4-24 months). There was no evidence of recurrence of BS at a mean follow-up of 12 months (range, 2-16 months). In 1 of 20 patients (5%) three courses of percutaneous stenting and bilioplasty were performed; there was no evidence of recurrence of BS at a mean follow-up of 10 months. In conclusion, BS is a major problem following pediatric liver transplantation. Radiological percutaneous treatment is safe and effective, avoiding, in most cases, surgical revision of the anastomosis.
Department of Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Via Tricomi 1, 90127, Palermo, Italy. rmiraglia@ismett.edu
Roberto
R
Miraglia
Luigi
L
Maruzzelli
Settimo
S
Caruso
Silvia
S
Riva
Marco
M
Spada
Angelo
A
Luca
Bruno
B
Gridelli
D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002675:Child, Preschool; D002758:Cholangiography / Q000379:methods; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome