3:54 PM Abstract No. 106 - Effectiveness of percutaneous and endoscopic therapy for biliary strictures and leaks after liver transplantation in children

Abstract

Purpose To determine the effectiveness of percutaneous and endoscopic therapeutic interventions for biliary strictures and leaks following liver transplantation in children. Materials and Methods Retrospective analysis of 38 consecutive pediatric patients (18 female, average age at transplant 5.9 years) treated at our institution from 1997 to 2010 for biliary leak and/or biliary stricture following liver transplantation (29 deceased donor liver transplants, 9 living related liver transplants) was performed. Six patients had a choledochocholedochostomy while the rest had a Roux-en-Y hepaticojejunostomy biliary anastomosis. Patients with a hepaticojejunostomy anastomosis were managed by a percutaneous approach (percutaneous transhepatic biliary drain placement followed by balloon dilation of the stricture), whereas endoscopic approach was feasible in 8 of the patients with choledochocholedochostomy. 32 patients had a stricture at the biliary anastomosis, while 6 patients had an anastomotic leak. Minimally invasive approach was considered clinically successful if it resulted in patency of the narrowed biliary segment ( Results After an average of 9.1 years of follow-up, non-surgical management was clinically successful for 4 patients (67%) with a biliary leak and for 20 patients (63%) with a stricture. Patients with a leak required a mean of 3.7 invasive procedures and spent a mean of 44.3 days with a transhepatic biliary catheter. Conversely, patients with a stricture had a mean of 7.1 invasive procedures, and spent a mean of 386 days with a transhepatic biliary catheter. Leak recurred in 1 patient. As a result, 3 patients (50%) with leaks ultimately required surgical intervention. Strictures recurred in 5 patients, and a total of 15 patients required surgical revision of the biliary anastomosis (47%). Conclusion Percutaneous and endoscopic management of biliary strictures and leaks after liver transplantation in children is associated with a durable result in approximately 50% of patients.