Stent Placement In Patients Research Articles

Safety of hyperbaric oxygen therapy for management of central airway stenosis after lung transplant.

Central airway stenosis (CAS) is common after lung transplantation and causes significant post-transplant morbidity. It is often preceded by extensive airway necrosis, related to airway ischemia. Hyperbaric oxygen therapy (HBOT) is useful for ischemic grafts and may reduce the development of CAS. The purpose of this study was to determine whether HBOT could be safely administered to lung transplant patients with extensive necrotic airway plaques. Secondarily, we assessed any effects of HBOT on the incidence and severity of CAS. Patients with extensive necrotic airway plaques within 1-2months after lung transplantation were treated with HBOT along with standard care. These patients were compared with a contemporaneous reference group with similar plaques who did not receive HBOT. Ten patients received HBOT for 18.5 (interquartile range, IQR 11-20) sessions, starting at 40.5 (IQR 34-54)days after transplantation. HBOT was well tolerated. Incidence of CAS was similar between HBOT-treated patients and reference patients (70% vs 87%, respectively; P=.34), but fewer stents were required in HBOT patients (10% vs 56%, respectively; P=.03). This pilot study is the first to demonstrate HBOT safety in patients who develop necrotic airway plaques after lung transplantation. HBOT may reduce the need for airway stent placement in patients with CAS.

Preoperative biliary stent placement in patients with pancreatic cancer

Preoperative biliary stent placement in patients with pancreatic cancer

Percutaneous Transhepatic Biliary Stent Implantation for Obstructive Jaundice of Perihilar Cholangiocarcinoma: A Prospective Study on Predictors of Stent Patency and Survival in 92 Patients

PurposeTo evaluate prognostic factors for stent patency and survival in patients with perihilar cholangiocarcinoma (pCCA) who underwent percutaneous biliary stent placement. Materials and MethodsThis prospective study followed 92 consecutive patients with pCCA who underwent metal stent placement between January 2013 and July 2014. Of the total number of patients, 11 had ascites, and 36 had biliary obstruction for > 1 month at the time of stent placement. Cumulative patency and survival rates were assessed with Kaplan-Meier curves, and independent predictors were calculated with Cox regression. A new formula was developed to predict patient survival. ResultsTumor size was significantly associated with stent patency (hazard ratio = 2.425; 95% confidence interval, 1.134–5.168). Independent predictors of survival included lymph node metastasis, intrahepatic mass lesion, cancer antigen 19-9 (CA19-9), ascites, and duration of jaundice. A new equation was developed to assess risk: R = 7 × (duration of biliary obstruction—0 if < 30 d, 1 if > 30 d) + 7 × (CA19-9—0 if < 500, 1 if > 500) + 7 × (ascites—0 if none present, 1 if ascites present) + 10 × (lymph node metastasis—0 if no metastasis, 1 if metastasis present) + 9 (intrahepatic mass lesion—0 if absent, 1 if present). Among patients who developed stent occlusion, patients who underwent recanalization of the occluded stent had longer survival compared with patients who did not undergo recanalization (109 d vs 29 d, P = .001). ConclusionsPrognostic factors for survival after percutaneous stent placement in patients with pCCA were tumor stage, duration of jaundice, CA19-9, and ascites. Tumor size affected stent patency. Prognosis for patients with reintervention after occlusion of the stent improved.

Safety and Efficacy of Percutaneous Biliary Covered Stent Placement in Patients with Malignant Biliary Hilar Obstruction; Correlation with Liver Function.

To estimate the safety and efficacy of percutaneous ePTFE-covered biliary stent placement and the relationship between underlying liver function and stent patency in patients with malignant hilar obstruction. From March 2012 to June 2015, 41 patients [22 females, 19 males; mean age 69.8 (range 34-94) years] with malignant biliary obstruction underwent percutaneous biliary stent placement (31 patients with unilateral, 10 patients with bilateral side-by-side). Cumulative patient survival and stent patency rate curves were derived using the Kaplan-Meier method. A Cox model was used to explore the relationship between liver function and patient survival, and also biliary stent patency. Pearson correlation coefficient was used to analyze the relationship between patient survival and stent patency. Technical success rate was 100% and clinical success rate was 95%. During follow-up, four complications occurred (two bilomas and two cases of acute cholecystitis) and were treated successfully with percutaneous drainage. No other complication occurred. Mean serum bilirubin level was 11.34±7.35mg/dL before drainage and 5.00±4.83mg/dL 2 weeks after stent placement. The median patent survival duration was 147days (95% CI, 69.6-224.4days). The median stent patency duration was 101days (95% CI, 70.0-132.0days). The cumulative stent patency rates at 1, 3, 6, and 12months were 97, 57.6, 30.3, and 17.0%, respectively. Child-Pugh score was correlated significantly with patient survival (P=0.011) and stent patency (P=0.007). MELD score was correlated significantly with stent patency (P=0.044). There was a correlation between patient survival and stent patency (r=0.778, P<0.001). Percutaneous placement of ePTFE-covered biliary stent was a safe and an effective method for malignant biliary obstruction. Underlying liver function seemed to be one of the important factors affecting patient survival and stent patency, and stent patency showed statistically significant correlation with patient survival.

Sa1490 The Safety and Efficacy of Pancreatic Duct Stent Placement in the Emergency ERCP of Acute Biliary Pancreatitis

Several prospective, randomized trials have demonstrated that early ERCP and biliary endoscopic sphincterotomy (ES) with/without stone extraction was superior in reducing the mortality and morbidity rates in acute biliary pancreatitis (ABP) compared with conservative treatment. Prophylactic pancreatic duct (PD) stent placement has been shown to reduce the risk of post-ERCP pancreatitis. However, there are few reports about PD stent placement in the emergency ERCP of ABP. The aim of current study was to evaluate the safety and effectiveness of emergency ERCP and PD stent placement in patients with ABP.

Incidence and Clinical Significance of Acute Reocclusion after Emergent Angioplasty or Stenting for Underlying Intracranial Stenosis in Patients with Acute Stroke.

A major concern after emergent intracranial angioplasty in cases of acute stroke with underlying intracranial stenosis is the acute reocclusion of the treated arteries. This study reports the incidence and clinical outcomes of acute reocclusion of arteries following emergent intracranial angioplasty with or without stent placement for the management of patients with acute stroke with underlying intracranial atherosclerotic stenosis. Forty-six patients with acute stroke received emergent intracranial angioplasty with or without stent placement for intracranial atherosclerotic stenosis and underwent follow-up head CTA. Acute reocclusion was defined as "hypoattenuation" within an arterial segment with discrete discontinuation of the arterial contrast column, both proximal and distal to the hypoattenuated lesion, on CTA performed before discharge. Angioplasty was defined as "suboptimal" if a residual stenosis of ≥50% was detected on the postprocedural angiography. Clinical and radiologic data of patients with and without reocclusion were compared. Of the 46 patients, 29 and 17 underwent angioplasty with and without stent placement, respectively. Acute reocclusion was observed in 6 patients (13%) and was more frequent among those with suboptimal angioplasty than among those without it (71.4% versus 2.6%, P < .001). The relative risk of acute reocclusion in patients with suboptimal angioplasty was 27.857 (95% confidence interval, 3.806-203.911). Furthermore, a good outcome was significantly less frequent in patients with acute reocclusion than in those without it (16.7% versus 67.5%, P = .028). Acute reocclusion of treated arteries was common after emergent intracranial angioplasty with or without stent placement in patients with acute stroke with intracranial atherosclerotic stenosis and was associated with a poor outcome. Suboptimal results of angioplasty appear to be associated with acute reocclusion, irrespective of whether stent placement was performed.

Evaluation of esophageal and airway stent placement for patients with advanced and recurrent esophageal cancer

Background Patients with advanced esophageal cancer frequently experience dysphagia and dyspnea, and relief of such symptoms is important. We wished to clarify the efficacy of endoscopic stent placement in patients with dysphagia or dyspnea caused by advanced esophageal cancer.

4:03 PMAbstract No. 404 - Outcomes of overlapping self-expandable metallic stent placement in patients with malignant gastroduodenal obstruction

4:03 PMAbstract No. 404 - Outcomes of overlapping self-expandable metallic stent placement in patients with malignant gastroduodenal obstruction

Tracheobronchial stents in mucopolysaccharidosis

IntroductionThe mucopolysaccharidoses are a group of hereditary disorders pathologically characterized by tissue accumulation of glycosaminoglycans due to deficient lysosomal metabolism which often leads to progressive airway stenosis and respiratory insufficiency. Relentless and treatment-refractory narrowing of the lower airways with ensuing severe limitation of quality of life is a challenging problem in mucopolysaccharidoses. Case reportsWe report 2 cases of MPS (Hunter's and Maroteaux-Lamy's syndrome resp.) in whom tracheal stents were placed to relieve severe tracheal obstruction. The first patient could be weaned from mechanical ventilation after stent placement but showed significant long-term stent-related morbidity. The second patient suffered a severe procedure-related complication due to positioning problems typical for MPS. ConclusionsVery good short-term success can be achieved with airway stent placement in patients with MPS and severe lower airway stenosis but a high risk of severe complications and important long-term morbidity have to be weighed against potential individual benefit.

Abstract 19: Multicenter Prospective Trial of Intracranial Stent Placement in Patients With Symptomatic High-grade Intracranial Stenosis

Purpose: Based on the results of SAMMPRIS trial, modifications in patient selection and procedural aspects for intracranial stent placement have been recommended. We performed a multicenter prospective single arm trial to determine if such modifications will result in lower rates of peri-procedural stroke and/or death. Materials and Methods: The study enrolled patients with recent transient ischemic attack or ischemic stroke (excluding lacunar ischemic events) related to high-grade (70-99% in severity) stenosis of a major intracranial artery. Patients were treated using angioplasty and self-expanding stent after 3 weeks of index ischemic event at one of the 10 high volume centers in China. An independent neurologist ascertained the occurrence of any stroke and/or death within one month after the procedure. Results: A total of 100 consecutive patients were recruited. The target lesions were located in middle cerebral artery [M1] (n=38, 38%), intracranial internal carotid artery (n=17, 17%), intradural vertebral artery (n=18, 18%), and basilar artery (n=27, 27%). The technical success rate of stent deployment with residual stenosis &lt;50% was 100%. The overall one-month stroke and/or death rate was 2% (95% confidence interval 0.7% - 4.7%). Two ischemic strokes occurred in pontine region (perforator distribution) in patients following angioplasty and stent placement for basilar artery stenosis. Conclusion: The results of this prospective multi-center study demonstrated that modifications in patient selection and procedural aspects can substantially reduce the one-month stroke and/or death rate following intracranial stent placement.

Factores asociados al fracaso en la colocación de catéteres doble J en pacientes con uropatía obstructiva por cáncer

AimTo analyze the clinical, imaging, and surgical factors that are associated with failed double-J stent placement in patients with obstructive uropathy due to cancer. Materials and methodsAn analytic, cross-sectional study was conducted. The variables analyzed were: age, sex, oncologic diagnosis, clinical stage, diagnostic time course, treatment received, preoperative laboratory studies (Hb, leuc, Cr, BUN, urea), imaging studies (US or CAT), and the surgical attempt to place the double-J stent. A comparative analysis was done between the failed and successful placement groups. Statistical analysis was carried out using the Mann-Whitney U test and the chi-square test, and finally, the odds ratio with a 95% confidence interval was employed. ResultsOf the 48 patients, 27 had failed double-J stent placement and 21 had successful placement. Risk factors for failed placement were elevated preoperative levels of urea≥40mg/dL (OR: 16.67, CI: 2.66-134.92 [P=.0001]), creatinine ≥ 2mg/dL (OR:7.27, CI:1.41-42.25 [P=.004]), and BUN ≥ 40mg/dL (OR:4.00, CI: 0.93-18.06 [P=.031]) and a low Hb level ≤ 9mg/dL (OR:6.32, CI:1.37-21.55 [P=.005]), as well as a deformed trigone (OR:3.29, IC:1.18-9.19 [P=.002]). ConclusionsElevated preoperative levels of creatinine, urea, and BUN, and a deformed bladder trigone are markers for failed double-J stent placement.

Endoscopic management of unresectable malignant gastroduodenal obstruction with a nitinol uncovered metal stent: A prospective Japanese multicenter study.

To determine the safety and efficacy of endoscopic duodenal stent placement in patients with malignant gastric outlet obstruction. This prospective, observational, multicenter study included 39 consecutive patients with malignant gastric outlet obstruction. All patients underwent endoscopic placement of a nitinol, uncovered, self-expandable metal stent. The primary outcome was clinical success at 2 wk after stent placement that was defined as improvement in the Gastric Outlet Obstruction Scoring System score relative to the baseline. Technical success was achieved in all duodenal stent procedures. Procedure-related complications occurred in 4 patients (10.3%) in the form of mild pneumonitis. No other morbidities or mortalities were observed. The clinical success rate was 92.3%. The mean survival period after stent placement was 103 d. The mean period of stent patency was 149 d and the patency remained acceptable for the survival period. Stent dysfunction occurred in 3 patients (7.7%) on account of tumor growth. Endoscopic management using duodenal stents for patients with incurable malignant gastric outlet obstruction is safe and improved patients' quality of life.

Endoscopic management of malignant biliary stenosis. Update and highlights for standard clinical practice.

The present review describes the various indications of biliary stent placement in patients with biliary malignancies. It deals in depth with biliary accesses and their effectiveness, as well as with the use of different stents according to lesion type and expected patient survival. For liver hilum lesions, which are somewhat more complex, the usefulness of and need for unilateral or bilateral drainage is assessed, as it is the most appropriate method. All in all, this is an up-to-date literature review that may help clinicians in their daily decision-making, as well as to improve and optimize patient outcomes.

Endovascular Stent Placement for May–Thurner Syndrome in the Absence of Acute Deep Vein Thrombosis

PurposeTo assess the clinical utility of iliac vein stent placement for patients with chronic limb edema or pelvic congestion presenting with nonocclusive May–Thurner physiology. Materials and MethodsAll patients (N = 45) undergoing stent placement for May–Thurner syndrome (MTS) without an associated acute thrombotic event between 2007 and 2014 were retrospectively reviewed; 11 were excluded for poor follow-up. A total of 34 patients (28 female) were studied (mean age, 44 y; range, 19–80 y). Average follow-up time was 649 days (median, 488 d; range, 8–2,499 d). ResultsThe technical success rate was 100% (34 of 34). No major and two minor (5%) complications occurred, and 68% of patients (23 of 34) had clinical success with relief of presenting symptoms on follow-up visits. Technical parameters including stent size and number, stent type, concurrent angioplasty, access site, and resolution of collateral iliolumbar vessels were not found to be statistically related to clinical success (P > .05). Similarly, no significant relation to clinical success was seen for clinical factors such as the type of symptoms, presence of chronic deep vein thrombosis (DVT), or concurrent coagulopathy (P > .05). Female sex was found to correlate with clinical success (82% vs 18%; P = .04). ConclusionsIliac stent placement in patients presenting with chronic limb or pelvic symptoms from MTS without acute DVT is associated with clinical success in the majority of patients.

Associations between Cerebral Embolism and Carotid Intraplaque Hemorrhage during Protected Carotid Artery Stenting.

Carotid artery stent placement in patients with intraplaque hemorrhage remains controversial because of the incidence of cerebral embolism after the procedure. The purpose of this study is to determine if intraplaque hemorrhage is a significant risk factor for cerebral embolism during carotid artery stent placement. This prospective study assessed 94 consecutive patients with severe carotid stenosis. These patients underwent preprocedural carotid MR imaging and postprocedural DWI after carotid artery stent placement. Intraplaque hemorrhage was defined as the presence of high signal intensity within the carotid plaque that was >200% of the signal from the adjacent muscle on MPRAGE. We then analyzed the incidence of postprocedural ipsilateral ischemic events on DWI and primary outcomes within 30 days of carotid artery stent placement. Forty-three patients (45.7%) had intraplaque hemorrhage on an MPRAGE image. There was no significant difference in the incidence of postprocedural ipsilateral ischemic events and primary outcomes between the intraplaque hemorrhage and non-intraplaque hemorrhage group. However, postprocedural ipsilateral ischemic events were more frequently observed in the symptomatic group (17/41 [41.5%]) than in the asymptomatic group (8/53 [15.1%]; P = .005). Intraplaque hemorrhage was not a significant risk factor for cerebral embolism during carotid artery stent placement in patients with severe carotid stenosis. Symptomatic patients should receive more careful treatment during carotid artery stent placement because of the higher risk of postprocedural ipsilateral ischemic events.

Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis.

The management of refractory benign esophageal strictures (RBESs) is challenging. Stent placement has been proposed as a possible rescue strategy. We performed a systematic review and meta-analysis to examine the efficacy of this strategy in the long-term resolution of dysphagia. PubMed, SCOPUS, and Google Scholar were searched (up to January 2015). Studies recruiting adults with RBES treated with stent placement were eligible. The success, adverse event, and migration rates were pooled by means of a random-effect model to obtain odds with a 95 % confidence interval (CI). Eighteen studies (444 patients) were eligible for inclusion. The pooled clinical success rate was 40.5 % (95 %CI 31.5 % - 49.5 %), yielding odds of 0.68 (95 %CI 0.46 - 0.98) with high heterogeneity (I(2) = 65.0 %). The meta-regression analysis showed stricture etiology as the only influencing factor. Treatment with self-expanding plastic (SEPSs) and metal stents (SEMSs) did not result in significantly higher success rates than treatment with biodegradable stents (BDSs) (46.2 % vs. 40.1 % vs. 32.9 %, respectively). The migration rate was 28.6 % (95 %CI 21.9 % - 37.1 %), yielding odds of 0.40 (95 %CI 0.28 - 0.59), with migration rates for SEPSs and SEMSs reported as being not significantly higher than BDSs (33.3 % vs. 31.5 % vs. 15.3 %, respectively). The adverse event rate was 20.6 % (95 %CI 15.3 % - 28.1 %), yielding odds of 0.26 (95 %CI 0.18 - 0.39) with no significant difference between stent types (19.4 % vs. 21.9 % vs. 21.9 %, respectively). Stent placement in patients with RBES is effective in about 40 % of cases. Further studies should investigate whether the clinical success rate varies according to the stricture etiology.(PROSPERO registration number: CRD42015019017.).

Long-Term Results of Stent Placement in Patients with Outflow Block After Living-Donor-Liver Transplantation.

To evaluate long-term results of stent placement retrospectively in patients with outflow block after living-donor-liver transplantation (LDLT). For this institutional review board approved retrospective study conducted during 2002-2012, stents were placed in outflow veins in 15 patients (11.3%, 15/133) (12 men; 3 female) in whom outflow block developed after LDLT. Their mean age was 52.3 years ± 15.3 (SD) (range, 4-69 years). Venous stenosis with a pressure gradient ≥5 mmHg (outflow block) was observed in the inferior vena cava in seven patients, hepatic vein in seven patients, and both in one patient. Technical success, change in a pressure gradient and clinical manifestations, and complications were evaluated. Overall survival of 15 patients undergoing outflow block stenting was compared with that of 116 patients without outflow block after LDLT. Stents were placed across the outflow block veins without complications, lowering the pressure gradient ≤ 3 mmHg in all patients (100%, 15/15). Clinical manifestations improved in 11 patients (73.3%, 11/15), and all were discharged from the hospital. However, they did not improve in the other 4 patients (26.7%, 4/15) who died in the hospital 1.0-3.7 months after stenting (mean, 2.0 ± 1.2 months). No significant difference in 5-year survival rates was found between patients with and without outflow block after LDLT (61.1 vs. 72.2%, p = .405). Stenting is a feasible, safe, and useful therapeutic option to resolve outflow block following LDLT, providing equal survival to that of patients without outflow block.

Safety and Effectiveness of Stent Placement for Iliofemoral Venous Outflow Obstruction: Systematic Review and Meta-Analysis.

Endovenous recanalization of iliofemoral stenosis or occlusion with angioplasty and stent placement has been increasingly used to maintain long-term venous patency in patients with iliofemoral venous outflow obstruction. The purpose of this systematic review and meta-analysis was to determine safety and effectiveness of venous stent placement in patients with iliofemoral venous outflow obstruction. We searched MEDLINE and EMBASE for studies evaluating safety or effectiveness of stent placement in patients with iliofemoral venous outflow obstruction. Data were extracted by disease pathogenesis: nonthrombotic, acute thrombotic, or chronic post-thrombotic. Main outcomes included technical success, periprocedural complications, symptom relief at final follow-up, and primary/secondary patency through 5 years. A total of 37 studies reporting 45 treatment effects (nonthrombotic, 8; acute thrombotic, 19; and chronic post-thrombotic, 18) from 2869 patients (nonthrombotic, 1122; acute thrombotic, 629; and chronic post-thrombotic, 1118) were included. Technical success rates were comparable among groups, ranging from 94% to 96%. Complication rates ranged from 0.3% to 1.1% among groups for major bleeding, from 0.2% to 0.9% for pulmonary embolism, from 0.1% to 0.7% for periprocedural mortality, and from 1.0% to 6.8% for early thrombosis. Patient symptom relief data were reported inconsistently. At 1 year, primary and secondary patency were 96% and 99% for nonthrombotic, 87% and 89% for acute thrombotic, and 79% and 94% for chronic post-thrombotic. Stent placement for iliofemoral venous outflow obstruction results in high technical success and acceptable complication rates regardless of cause of obstruction.

A Safe Method of Tracheal Polyflex Stent Placement: A Review of 20 Patients.

Background:Surgery is an appropriate therapeutic approach for tracheal stenosis due to various benign and malignant conditions. When surgery is postponed for certain reasons, other options are chosen for airway patency. One alternative is using airway stents.Objectives:We aimed to introduce a safe method of tracheal polyflex stent placement in patients with tracheal stenoses.Patients and Methods:During a 7-year period (2002 - 2008), polyflex stents were used 29 times among 20 patients for various indications. After encountering many difficulties in earlier cases, we gradually developed our new method and used it in most of our patients. In this method, without using large rigid bronchoscopes, the introducer tube could be used as a bronchoscope with the aid of a zero-degree lens and ventilating apparatus. In this method, the rate of possible trauma to the airway can be minimized by avoiding the use of thick rigid bronchoscopies and the stent can be placed faster and more accurately.Results:Polyflex stents were used in 11 men (55%) and 9 women with a mean age of 38.5 years. Stents were removed and changed in 12 cases and replaced with another type of stent in 3 patients. Indications were recurrence of tracheal stenosis (7), multisegmental tracheal stenosis (3), anesthesia limitations (3), tracheal tumors (2), dehiscence of tracheal anastomosis (1), severe inflammation of the tracheal mucosa (1), esophagobronchial fistula (1), and external pressure on the left main bronchus (1). In one patient, a stent was used to open a kinked Dumon stent as a temporary life-saving procedure. We found 6 cases of stent migration, 3 cases of granulation tissue formation, 1 case of infection, and 1 case of surgical site dehiscence.Conclusions:Stents would be regarded as a temporary means of reaching the ideal condition for resection and reconstruction in most patients with tracheal stenoses. Although an optimal stent has not been introduced yet, we used polyflex stents in most of our patients with tracheal stenosis due to its availability and ease of use. We suggest that this method is safe and less time consuming than its traditional method of placement.

Long-term outcome of endovascular intervention in hepatic venous outflow obstruction following pediatric liver transplantation.

The purpose of our study was to address the long-term outcome of angioplasty and stent placement for hepatic venous outflow obstruction following pediatric liver transplantation. From October 1999 to December 2011, 20 stenotic lesions were confirmed to constitute hepatic venous outflow obstruction in 18 pediatric patients (13 boys, 5 girls) among 152 pediatric patients following liver transplantation and were managed with endovascular intervention. Stent placement was favored over additional angioplasty in patients of preadolescent or adolescent age (>8 years old), after 1 or 2 sessions of balloon angioplasty. The primary patency and assisted primary patency were estimated using the Kaplan-Meier method. A total of 32 procedures (24 balloon angioplasties, 8 stent placements) were conducted. The technical success rate was 90.6% (29/32). Clinical success was achieved in 15 of 18 patients (clinical success rate of 83.3%). Major complications did not occur in our study. Median follow-up was 91.5 months (interquartile range, 54.7-137.3 months) for the 18 patients. The 1-year, 3-year, 5-year, and 10-year primary patencies of the 20 treated lesions were 63.5%, 57.8%, 57.8%, and 57.8%, respectively. The 1-year, 3-year, 5-year, and 10-year assisted-primary patencies of the lesions were 100%, 100%, 100%, and 100%, respectively. Of the 6 patients of preadolescent or adolescent age, 5 patients underwent stent placement procedures, and the stents were patent during the follow-up period of 57.3-162.5 months (median, 72.7 months). In conclusion, endovascular intervention is very effective in hepatic venous outflow obstruction following pediatric liver transplantation. In addition, early stent placement in patients of preadolescent or adolescent age can provide a safe and favorable long-term outcome.