Monday November 12, 2018 from 17:00 to 18:00
Percutaneous Treatment of Biliary Strictures after Pediatric Liver Transplantation
Dorota Jarzębicka1, Małgorzata Markiewicz-Kijewska2, Kazimierz Janiszewski3, Małgorzata Rurarz1, Piotr Kaliciński2, Jan Pertkiewicz3, Diana Kamińska1, Irena Jankowska1, Mikołaj Teisseyre1, Marek Szymczak2, Joanna Pawłowska1, Piotr Czubkowski1.
1Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland; 2Department of Pediatric Surgery and Transplantation, The Children's Memorial Health Institute, Warsaw, Poland; 3Endotherapy, Endotherapy, Warsaw, Poland
Background: Biliary strictures (BS) are frequent after pediatric liver transplantation (LTx) and in spite of the ongoing progress they remain a significant cause of morbidity. In children the majority of reconstruction is hepatico-jejunal anastomosis (HJA). The aim of the study was to analyze our experience in percutaneous transhepatic treatment of BS.
Material and Methods: Between 1998 and 2014, 589 (269 living donor) pediatric LTx were performed in our institution. We retrospectively review clinical data of patients with HJA who developed BS and underwent percutaneous transhepatic biliary drainage (PTBD).
Results: Out of 400 patients with HJA 35 patients developed BS. There were 27 (77%) anastomotic BS (ABS) and 8 (23%) multilevel BS (MBS). Ninety-two PTBD (2.5 per patient) were performed with successful outcome in 20 (57%). Fifteen patients after failed PTBD underwent surgery which was successful in 11 cases. Overall good outcome was achieved in 31 (88%) cases. The most common complication of PTBD was cholangitis which occurred in 5.4%. We did not find any risk factors of PTBD failure, except the treatment before 2007 which was related with poor prognosis.
Conclusions: Percutaneous treatment is effective and safe in BS and is recommended as a first line approach. The majority of patients require multiple interventions but overall risk of complications is low. Surgery is essential in selected cases and always should be considered if PTBD fails.