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Percutaneous yttrium aluminum garnet–laser lithotripsy of intrahepatic stones and casts after liver transplantation
Author(s) -
Schlesinger Nis Hallundbæk,
Svenningsen Peter,
Frevert Susanne,
Wettergren André,
Hillingsø Jens
Publication year - 2015
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.24120
Subject(s) - medicine , liver transplantation , lithotripsy , percutaneous , surgery , bile duct , laser lithotripsy , cholangiography , balloon dilation , transplantation , balloon
Bile duct stones and casts (BDSs) contribute importantly to morbidity after liver transplantation (LT). The purpose of this study was to estimate the clinical efficacy, safety, and long‐term results of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in transplant recipients and to discuss underlying factors affecting the outcome. A retrospective chart review revealed 18 recipients with BDSs treated by PTCSL laser lithotripsy with a holmium–yttrium aluminum garnet laser probe at 365 to 550 µm. They were analyzed in a median follow‐up time of 55 months. In all but 1 patient (17/18 or 94%), it was technically feasible to clear all BDSs with a mean of 1.3 sessions. PTCSL was unsuccessful in 1 patient because of multiple stones impacting the bile ducts bilaterally; 17% had early complications (Clavien II). All biliary casts were successfully cleared; 39% had total remission; 61% needed additional interventions in the form of percutaneous transhepatic cholangiography and dilation (17%), re‐PTCSL (11%), self‐expandable metallic stents (22%), or hepaticojejunostomy (6%); and 22% eventually underwent retransplantation. The overall liver graft survival rate was 78%. Two patients died during follow‐up for reasons not related to their BDS. Nonanastomotic strictures (NASs) were significantly associated with treatment failure. We conclude that PTCSL in LT patients is safe and feasible. NASs significantly increased the risk of relapse. Repeated minimally invasive treatments, however, prevented graft failure in 78% of the cases. Liver Transpl 21:831–837, 2015 . © 2015 AASLD.