Treatment of Refractory Benign Biliary Stenoses in Liver Transplant Patients by Placement and Retrieval of a Temporary Stent-Graft: Work in Progress

Abstract

To evaluate patency of refractory benign biliary strictures in liver transplant patients treated with retrievable stent-grafts. Eight male liver transplant patients who ranged in age from 42 to 52 years developed nine symptomatic biliary strictures (intrahepatic left duct, 1; hilar, 2; anastomotic, 6). These strictures had recurred despite multiple previous attempts of treatment (n = 33), including angioplasty (n = 27), surgery (n = 1), atherectomy (n = 1), metallic stent (n = 1), and prolonged catheter drainage (n = 3). As an alternative method of treatment for these refractory biliary strictures, transhepatic placement of expanded polytetrafluoroethylene stent-grafts across the strictures was performed through 10-F sheaths. In total, 14 stent-grafts were placed to treat the nine lesions, and nine of these stent-grafts were subsequently retrieved through 12-16-F sheaths. Stent-grafts were deployed successfully. Delayed migrations in two patients required additional stent-graft placement. One patient died of pneumonia 1 month after stent-graft placement; the remaining seven patients had stent-grafts successfully removed at 3-10 months (mean, 5.6 months). Nine intended stent-graft retrievals were performed successfully, with two requiring use of elongated forceps. Immediately after treatment, all strictures were widely patent. Five to 6 months after stent-graft removal in these seven patients, significant strictures recurred in four of eight lesions (50%). One patient underwent surgical revision. At 6-29 months (mean, 12 months) after stent-graft removal, the remaining six patients were without clinical or laboratory evidence of biliary obstruction, despite three patients with significant recurrent strictures. Temporary stent-graft placement for treatment of benign biliary strictures in liver transplant patients is technically feasible. Longer follow-up with larger patient series is necessary to assess effectiveness and possible broader applications.