Clinical Study
Long-Term Outcome of Percutaneous Biliary Interventions for Biliary Anastomotic Stricture in Pediatric Patients after Living Donor Liver Transplantation with Roux-en-Y Hepaticojejunostomy

https://doi.org/10.1016/j.jvir.2015.07.029Get rights and content

Abstract

Purpose

To retrospectively evaluate long-term outcomes of percutaneous transhepatic biliary drainage (PTBD) followed by balloon dilation and placement of an internal drainage tube for anastomotic stricture in pediatric patients who underwent living donor liver transplantation (LDLT) with Roux-en-Y hepaticojejunostomy (RYHJ).

Materials and Methods

Fifty-two patients (23 male, 29 female; median age, 5 y) with anastomotic biliary stricture were treated with PTBD followed by balloon catheter dilation and long-term placement of an internal drainage tube, which was removed upon cholangiographic confirmation of free flow of bile into the small bowel. Clinical success, tube independence rate, risk factors of recurrent biliary stricture, and patency rates were evaluated.

Results

Thirty-nine patients (75%) had no stricture recurrence. Of 13 patients (25%) with recurrence, six were treated again with the same percutaneous biliary interventions and showed no further recurrence. Clinical success was noted in 43 of 52 patients (83%). Drainage tubes were removed from 49 patients (94%). Multivariate logistic regression analysis indicated that serum alanine aminotransferase level > 53 IU/L at discharge after the initial series of percutaneous biliary interventions was a significant risk factor for recurrent biliary stricture (P = .002). Kaplan–Meier analysis showed 1-, 3-, 5-, and 10-year primary and primary assisted patency rates of 75%, 70%, 70%, and 68%, and 94%, 92%, 88%, and 88%, respectively.

Conclusions

PTBD followed by balloon dilation and internal drainage may be an effective treatment for anastomotic biliary stricture after pediatric LDLT with RYHJ.

Section snippets

Materials and Methods

Our institutional review board approved this retrospective study and waived the informed consent requirement.

Results

PTBD followed by balloon dilation and placement of an internal drainage tube was performed in 52 patients (Fig 1). After tube removal, 39 patients (75%) had no recurrence (Fig 2) and 13 patients (25%) showed recurrent stricture. In 39 patients, an internal drainage tube was placed for 1–31 months (median, 4 mo) during the initial series of percutaneous biliary interventions and was then removed. No recurrent biliary strictures were observed for 6–150 months (median, 49 mo). However, two of the

Discussion

Although biliary complication rates following liver transplantation have been decreasing as a result of improvements in surgical techniques, they remain one of the most important problems associated with liver transplantation because of their high associated morbidity and mortality rates (14). Various biliary complications, including biliary stricture, biliary leak, biliary stones, biloma, and hemobilia have been noted in posttransplantation patients. The two main biliary complications are

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    From the SIR 2015 Annual Meeting.

    None of the authors have identified a conflict of interest.

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