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

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.

• Authors: Rinpei Imamine, Toshiya Shibata, Minoru Yabuta, Ken Shinozuka, Masako Kataoka, Hiroyoshi Isoda, Atsushi Yoshizawa, Shinji Uemoto, Kaori Togashi
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 26 Issue 12 Pg. 1852-9 (Dec 2015) ISSN: 1535-7732 [Electronic] United States
• PMID: 26342884 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Anastomosis, Roux-en-Y (adverse effects)
• Child
• Child, Preschool
• Cholestasis (etiology, surgery)
• Drainage (methods)
• Female
• Follow-Up Studies
• Hepatectomy (adverse effects)
• Humans
• Infant
• Jejunostomy (adverse effects)
• Liver Transplantation (adverse effects)
• Living Donors
• Longitudinal Studies
• Male
• Retrospective Studies
• Treatment Outcome