Premium
Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation
Author(s) -
Ko GiYoung,
Sung KyuBo,
Yoon HyunKi,
Kim Kyung Rae,
Gwon Dong Il,
Lee Sung Gyu
Publication year - 2008
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21507
Subject(s) - medicine , liver transplantation , anastomosis , percutaneous , living donor liver transplantation , surgery , biliary tract surgical procedures , transplantation , general surgery , biliary tract
Endoscopic treatment has largely replaced surgery as the initial treatment for biliary strictures following living donor liver transplantation; however, this treatment is nearly impossible in patients who have previously undergone hepaticojejunostomy (HJ). We therefore retrospectively evaluated the efficacy of percutaneous transhepatic treatment in patients who developed HJ strictures following living donor liver transplantation. Percutaneous transhepatic biliary drainage and subsequent balloon dilation of biliary strictures were performed on 83 patients. Serial exchanges of drainage tubes with larger diameters up to 14 Fr were performed at 4‐week intervals. Drainage tubes were removed if follow‐up cholangiography revealed fluent passage of the contrast medium without recurrence of symptoms or changes in the biochemical findings. The clinical outcome, tube independence rate, and patency rate following drainage tube removal were retrospectively evaluated. Except for 2 patients who had failed negotiation of biliary strictures, clinical success was achieved in all 81 patients following percutaneous transhepatic treatment, and the drainage tubes were removed from 76 (93.8%) of these 81 patients. Tubes were removed 11.2 ± 7.4 months after initial percutaneous transhepatic biliary drainage. The recurrence rate at a mean of 36.0 ± 26.2 months following drainage tube removal was 15.8%. One‐ and three‐year primary patency rates were 95.3% ± 2.7% and 80.9% ± 5.2%, respectively. In conclusion, percutaneous transhepatic treatment is an effective alternative treatment for HJ strictures following living donor liver transplantation. However, further research will be required in order to minimize the duration of treatment and the stricture recurrence rate following tube removal. Liver Transpl 14:1323–1332, 2008. © 2008 AASLD.