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Evaluation of a three‐session biliary dilation protocol following transplant‐related biliary stricture in pediatric patients
Author(s) -
Reis Stephen P.,
Bruestle Karina,
Brejt Sidney,
TulinSilver Sheryl,
Frenkel Joseph,
Mobley David G.,
England Ryan W.,
Sobolevsky Sergei,
Griesemer Adam D.,
Sperling David,
Schlossberg Peter,
Susman Jonathan,
Weintraub Joshua L.
Publication year - 2019
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.13551
Subject(s) - medicine , balloon dilation , biliary drainage , liver transplantation , percutaneous , surgery , dilation (metric space) , biliary tract , waiting list , balloon , transplantation , mathematics , combinatorics
To evaluate whether a serial biliary dilation protocol improves outcomes and decreases total biliary drainage time for biliary strictures following pediatric liver transplantation. From 2006 to 2016, 213 orthotopic deceased and living related liver transplants were performed in 199 patients with a median patient age of 3.1 years at a single pediatric hospital. Patients with biliary strictures were managed by IR or surgically by the transplant team. Patients managed by IR were divided into two groups. The first group was managed with a standardized three‐session protocol consisting of dilation every two weeks for three dilations. The second group was managed clinically with varying number and interval of dilations as determined by a multidisciplinary team. The location of biliary stricture, duration of drainage, number of balloon dilations, balloon diameter, time interval between dilations, and success of percutaneous treatment were recorded. Thirty‐four patients developed biliary strictures. Thirty‐one patients were managed with percutaneous intervention. Three strictures could not be crossed and were converted to operative management. Ten patients were managed in the three‐session protocol, and 18 patients were managed in the clinically treated group. There was no significant difference in clinical success rates between groups, 80% and 61%, respectively. The three‐session protocol group trended toward a lower total biliary drain indwell time (median 49 days) compared with the clinically treated group (median 89 days), P = .089. Our study suggests that a three‐session dilation protocol following transplant‐related biliary stricture may decrease total biliary drainage time for some patients.