Management of Biliary Stricture in Pediatric Living Donor Liver Transplantation Recipients

• Published in: Transplantation proceedings 2020-07, Vol.52 (6), p.1844-1848
• Main Authors: Lin, An-Ni, Ou, Hsin-You, Huang, Tung-Liang, Tsang, Leung-Chit, Chen, Chao-Long, Cheng, Yu-Fan
• Format: Article
• Language: English
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2020.02.132

Evaluation of the efficiency of percutaneous transhepatic cholangial drainage (PTCD) for biliary stricture after living donor liver transplantation (LDLT) in pediatric patients. We retrospectively analyzed biliary stricture observed in pediatric biliary atresia. LDLT patients were studied between June 1994 and November 2017. A total of 291 patients were observed, 10 of whom were found to have biliary strictures. Among the 291 patients, we observed 10 patients with biliary stricture, which were divided into 2 groups: group A were patients who have biliary stricture with vascular complication (n = 4), and group B were patients who have biliary stricture without vascular complication (n = 4). Two children without vascular complications received PTCD to bridge the time for Rou-en-Y hepaticojejunostomy. A total of 12 procedures were carried out: only 1 patient (10%) underwent the procedure 3 times. The average interval between liver transplantation and percutaneous transhepatic drainage was 63.2 months in group A and 156.9 months in group B, and no significant difference between the 2 groups (P = .127). Clinical success was achieved in all patients. The PTCD was removed from 3 of 4 patients (75%) in group B with clinical success at a mean follow-up of 32.2 months. Higher PTCD removal rate (75%, P < .05) was found in the patients without vascular complication. All of the patients in group A were tube dependent during follow-up. No major complications were observed among all procedures. PTCD is an effective rescue therapy in pediatric LDLT patients, especially in nonvascular complication patients. Successful internal-external drainage and stenting can prevent a second operation for bile duct reconstruction. •Post-transplantation biliary stenosis in patients without vascular complication showed higher tube independence rate compared with patients with vascular complication.•Proper drainage with PTCD can prevent the patients with vascular complication from graft loss and reoperation.•Single-session balloon dilation plus large-bore drainage catheter is an effective and approachable method for post-transplantation biliary stricture pediatric patients.