Management of Biliary Stricture in Pediatric Liver Transplantation Patients: Long-Term Outcomes.

Autor: Yan KL; School of MedicineDavid Geffen School of Medicine at UCLA, University of California, Los AngelesLos AngelesCA., Gomes AS; School of MedicineDavid Geffen School of Medicine at UCLA, University of California, Los AngelesLos AngelesCA.; Department of Radiological SciencesDavid Geffen School of Medicine at UCLAUniversity of California, Los AngelesLos Angeles., Monteleone PA; Department of Radiological SciencesDavid Geffen School of Medicine at UCLAUniversity of California, Los AngelesLos Angeles., Venick RS; Department of Pediatric GastroenterologyDavid Geffen School of Medicine at UCLA, University of California, Los AngelesLos AngelesCA., McDiarmid SV; Department of Pediatric GastroenterologyDavid Geffen School of Medicine at UCLA, University of California, Los AngelesLos AngelesCA., Vargas JH; Department of Pediatric GastroenterologyDavid Geffen School of Medicine at UCLA, University of California, Los AngelesLos AngelesCA., Farmer DG; Department of Surgery, Liver TransplantationDavid Geffen School of Medicine at UCLA, University of California, Los AngelesLos AngelesCA.
Jazyk: angličtina
Zdroj: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2021 Dec; Vol. 27 (12), pp. 1788-1798. Date of Electronic Publication: 2021 Aug 29.
DOI: 10.1002/lt.26095
Abstrakt: Postoperative biliary complications have been reported to occur in 10% to 33% of pediatric liver transplantation (LT) recipients. Percutaneous intervention has become the primary treatment method for these complications; however, the efficacy and outcomes of these patients have not been well studied. Institutional pediatric LT from 1998 to 2019 were retrospectively reviewed to determine the patients referred for percutaneous treatment of post-LT biliary strictures. Clinical parameters, percutaneous transhepatic cholangiograms (PTCs), biliary catheter placement, cholangioplasty, and long-term outcomes were analyzed. Of the 396 consecutive pediatric LT recipients during our study period, 50 (12.6%) were diagnosed with biliary strictures on PTC. LT biliary reconstructions were Roux-en-Y hepaticojejunostomy in 28 patients (56%), choledochojejunostomy in 11 patients (22%), and choledochocholedochostomy in 11 patients (22%). Median age at LT was 23.2 months (interquartile range [IQR], 10.9-90.6), and 14 patients (28%) developed hepatic artery thrombosis. A total of 44 patients (88%) were treated with internal/external biliary catheters, of whom 38 (76%) underwent balloon cholangioplasty. By 12 months, 84% of patients had complete stricture resolution and catheter removal. Median total duration of catheter drainage was 152 days (IQR, 76-308). A total of 8 patients required additional surgery (biliary reconstruction or repeat LT [re-LT]) or died with a drainage catheter in place from complications unrelated to PTC intervention. Among the 6 patients (12%) treated with unilateral external biliary drainage catheters, 2 had catheters removed for inadequate drainage but then had spontaneous biliary obstruction resolution, 1 underwent duct reconstruction, and 3 required long-term catheterization. Biliary strictures following pediatric LT can be successfully treated with internal/external biliary drainage catheters and cholangioplasty if the stricture can be crossed. However, patients with isolated strictured ducts may require long-term external catheter drainage until re-LT or percutaneous obliteration of isolated ducts.
(Copyright © 2021 by the American Association for the Study of Liver Diseases.)
Databáze: MEDLINE
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