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Outcomes after discontinuation of routine use of transanastomotic biliary stents in pediatric liver transplantation at a single site
Author(s) -
Valentino Pamela L.,
Jonas Maureen M.,
Lee Christine K.,
Kim Heung B.,
Vakili Khashayar,
Elisofon Scott A.
Publication year - 2016
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12729
Subject(s) - medicine , liver transplantation , biliary atresia , biliary stent , percutaneous transhepatic cholangiography , cholangiography , discontinuation , surgery , retrospective cohort study , biliary tract , randomized controlled trial , biliary tract surgical procedures , single center , transplantation , stent
Routine use of transanastomotic biliary stents (RTBS) for biliary reconstruction in liver transplantation ( LT ) is controversial, with conflicting outcomes in adult randomized trials. Pediatric literature contains limited data. This study is a retrospective review of 99 patients who underwent first LT (2005–2014). In 2011, RTBS was discontinued at our center. This study describes biliary complications following LT with and without RTBS . 56 (56%) patients had RTBS . Median age at LT was 1.9 yr ( IQR 0.7, 8.6); 55% were female. Most common indication for LT was biliary atresia (36%). Most common biliary reconstruction was Roux‐en‐Y choledochojejunostomy (75% with RTBS , 58% without RTBS , p = 0.09). Biliary complications (strictures, bile leaks, surgical revision) occurred in 23% without significant difference between groups (20% with RTBS , 28% without RTBS , p = 0.33). Patients with RTBS had routine cholangiography via the tube at 6–8 wk; thus, significantly more patients with RTBS had cholangiograms (91% vs. 19%, p < 0.0001). There was no difference in the number of patients who required therapeutic intervention via endoscopic or percutaneous transhepatic cholangiography (11% with RTBS , 19% no RTBS , p = 0.26). Routine use of RTBS for biliary reconstruction in pediatric LT may not be necessary, and possibly associated with need for costlier, invasive imaging without improvement in outcomes.