An-Ni Lin1, Hsin-You Ou1, Tung-Liang Huang1, Leung-Chit Tsang1, Chao-Long Chen2, Yu-Fan Cheng3. 1. Liver Transplantation Program and Departments of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao-Sung, Kaohsiung, Taiwan. 2. Liver Transplantation Program and Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao-Sung, Kaohsiung, Taiwan. 3. Liver Transplantation Program and Departments of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niao-Sung, Kaohsiung, Taiwan. Electronic address: prof.chengyufan@gmail.com.
Abstract
OBJECTIVE: Evaluation of the efficiency of percutaneous transhepatic cholangial drainage (PTCD) for biliary stricture after living donor liver transplantation (LDLT) in pediatric patients. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
OBJECTIVE: Evaluation of the efficiency of percutaneous transhepatic cholangial drainage (PTCD) for biliary stricture after living donor liver transplantation (LDLT) in pediatric patients. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: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.