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Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation.
- Source :
-
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2003 Apr; Vol. 9 (4), pp. 394-400. - Publication Year :
- 2003
-
Abstract
- The purpose of this study was to evaluate the results of percutaneous transhepatic management (PTM) of anastomotic biliary strictures (BS). Among 168 liver transplant adult recipients, BS was identified in 30 patients. In 6 patients, narrowing of the anastomosis was found early, and in all cases disappeared spontaneously with prolonged draining of the bile tube. Within a mean time of 14 months after transplantation, 24 patients had symptomatic BSs, revealed by cholestasis (n = 17) or cholangitis (n = 7). Twenty-two patients underwent PTM as first treatment of BS (balloon dilatation or stent placement). We evaluated the primary and secondary patency rate of PTM. In 1 patient, PTM failed because the stricture could not be passed with the guide wire, necessitating conversion to a Roux-en-Y choledochojejunostomy (CDJ). Fourteen patients were treated by percutaneous balloon dilatation from which 8 patients (57.2%) were recurrence-free with a mean follow-up of 61 months. One patient with a patent biliary anastomosis underwent retransplantation for acute rejection. Twelve patients received metallic expandable stent placement as their primary treatment (n = 7) or after failure of balloon dilatation (n = 5). Recurrent stricture was found in 7 cases (58%) and was treated by PTM (n = 6) or surgery (n = 1). The primary patency rate for PTM was 58.8% at 12 months and the secondary patency rate 88.4%, with a mean follow-up of 47 months (median: 44 months). The mortality rate was 3.5% (one death). PTM with balloon dilatation, stent placement, or both, represent a safe method to treat anastomotic BSs after orthotopic liver transplantation (OLT) resulting in a secondary patency rate of 88% at 5 years.
- Subjects :
- Acute Disease
Adolescent
Adult
Aged
Cholestasis mortality
Drainage adverse effects
Drainage methods
Female
Follow-Up Studies
Graft Rejection surgery
Humans
Male
Middle Aged
Reoperation
Retrospective Studies
Stents adverse effects
Treatment Outcome
Catheterization adverse effects
Cholestasis etiology
Cholestasis therapy
Liver Transplantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1527-6465
- Volume :
- 9
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
- Publication Type :
- Academic Journal
- Accession number :
- 12682893
- Full Text :
- https://doi.org/10.1053/jlts.2003.50052