title: Biliary strictures after liver transplantation: is percutaneous treatment indicated?
abstract: BACKGROUND
  Biliary complications are common after orthotopic liver transplantation. Our study's aim is to evaluate the efficacy of percutaneous treatment of biliary strictures after orthotopic liver transplantation (OLT).
  
  
  METHODS
  Sixty-five patients with biliary anastomotic strictures received percutaneous transhepatic balloon cholangioplasty (PTBC). Three dilatations were performed with a 2- to 4-week period between the procedures. Primary and secondary patency were evaluated, with a follow-up between 6 months and 6 years.
  
  
  RESULTS
  PTBC successfully treated strictures in 52.3% (34/65) of cases. The normalization of clinical and biological features was noted at 2.3 months on average. Neither intercurrent episodes of sepsis nor a worsening of liver function were noted during the treatment; a significant complication was recorded in 8 patients. No patient needed surgery for the treatment of complications after PTBC. Factors related to a successful PTBC included older age at transplantation and single-site stricture. There were 7 recurrent strictures after PTBC, all successfully treated by nonsurgical procedures. The number of dilatations performed affected both the likelihood of success and the long-term risk of stricture recurrence. Of the 31 PTBC failures, 19 underwent subsequent surgical revision, 8 were treated endoscopically, and 4 were re-transplanted. Multifocal stenoses, central hepatic duct involvement, and intrahepatic localization resulted associated with treatment failure.
  
  
  CONCLUSIONS
  PTBC should be considered as a first choice option for treatment of biliary strictures after liver transplantation as well as endoscopic treatment. For solitary extrahepatic strictures that fail PTBC and ERCP, surgical revision provides good results.
authors.affiliation: Pôle des Pathologies Digestives, Hépatiques, et de la Transplantation, Hôpital de Hautepierre, Universite de Strasbourg, France. tullio.piardi@chru-strasbourg.fr
authors.forename: Tullio
authors.initials: T
authors.lastname: Piardi
authors.forename: Michael
authors.initials: M
authors.lastname: Greget
authors.forename: Maxim
authors.initials: M
authors.lastname: Audet
authors.forename: GianFranco
authors.initials: G
authors.lastname: Calandra
authors.forename: Federico
authors.initials: F
authors.lastname: Gheza
authors.forename: Bernard
authors.initials: B
authors.lastname: Ellero
authors.forename: Marrie-Lorraine
authors.initials: ML
authors.lastname: Woehl-Jaegle
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Cantu
authors.forename: Nazario
authors.initials: N
authors.lastname: Portolani
authors.forename: Philippe
authors.initials: P
authors.lastname: Wolf
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
mesh_terms: D000328:Adult; D000367:Age Factors; D000800:Angioplasty, Balloon / Q000379:methods*; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome