[Long term follow-up of bile duct stenosis treated with interventional radiology in pediatric liver transplantation].
The reported incidence of biliary strictures following pediatric liver transplantation has ranged between 5-34%, with a higher incidence in segmental grafts. Currently, percutaneous transhepatic balloon dilatation of biliary strictures is considered as the first line treatment owing to its minimal invasiveness. Between 1995-2006, 20 children who underwent liver transplantation developed biliary complications treated with interventional radiology. 16/20 developed biliary stricture, of whom 10 were treated with percutaneous transhepatic balloon dilatation. The mean age at the procedure was 6.6 years (range 8 m--14 years). The allograft types included whole (n=4), split (n=3), and reduced (n=3) livers. The procedure was performed at a mean time post-transplantation of 2.6 years. All patients are alive with a mean follow-up post-procedure of 24 months (range: 4 months-11 years). Currently, only 4 have a normal appearing biliary tree by imaging techniques and 6 developed stricture recurrence; of whom 3 developed biliary cirrhosis (2 splits, 1 reduced), one patient underwent successful rescue surgery, one was treated again percutaneously, and the remaining was lost to followup. In conclusion, treatment of percutaneous transhepatic balloon dilatation of biliary strictures is effective avoiding surgical correction. However, stricture recurrence in the medium- long term follow-up is frequent, particularly in segmental grafts. [corrected]
Brun
N
N
Servicio de Cirugía Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona. nuriabrun@hotmail.com
Bueno
J
J
Pérez
M
M
Venturi
C
C
Giné
C
C
Lloret
J
J
Segarra
A
A
Martínez Ibáñez
V
V
Charco
R
R
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002779:Cholestasis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D011859:Radiography; D015642:Radiology, Interventional; D013997:Time Factors