Long-term follow-up of percutaneous transhepatic balloon cholangioplasty in the management of biliary strictures after liver transplantation
- 15 January 2004
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Transplantation
- Vol. 77 (1), 110-115
- https://doi.org/10.1097/01.tp.0000101518.19849.c8
Abstract
This study evaluated the efficacy of a protocol of initial balloon dilation for biliary strictures after liver transplantation. Complete records from 96 patients with biliary strictures were retrospectively reviewed. Seventy-six patients received percutaneous transhepatic balloon cholangioplasty (PTBC) after initial placement of biliary drainage (percutaneous transluminal cholangiography [PTC]) tube. In most cases, three dilations were performed with a 4 to 8 week interval between procedures. Follow-up ranged from 6 months to 10 years. PTBC successfully treated strictures in 39 of 76 (51.3%) cases. Factors favoring successful PTBC included older age at transplant, shorter cold ischemic time, and single strictures. There were nine recurrent strictures after PTBC, all of which were successfully treated by nonoperative measures. The number of dilations performed affected both the likelihood of success and the long-term risk of stricture recurrence. Of the 37 PTBC failures, 14 underwent subsequent surgical revision. When both angiographic and surgical modalities were considered, treatment success was associated with first transplants, shorter cold ischemic time and operative time, and less intraoperative transfusion requirements. Factors associated with treatment failure included multiple, central hepatic duct, and intrahepatic strictures. PTC-tube independence was achieved in 51 of 76 (67%) patients using the combined approach of PTBC and surgery for PTBC failures. PTBC is an effective initial modality for treating posttransplant biliary strictures. Prolonged cold ischemic and operative times and multiple or peripheral strictures predispose to treatment failure. Solitary extrahepatic strictures that fail PTBC are salvageable with surgical revision with excellent results.Keywords
This publication has 17 references indexed in Scilit:
- INCIDENCE AND MANAGEMENT OF BILIARY COMPLICATIONS AFTER 291 LIVER TRANSPLANTS FOLLOWING THE INTRODUCTION OF TRANSCYSTIC STENTINGTransplantation, 1998
- A prospective randomised trial of bile duct reconstruction at liver transplantation: T tube or no T tube?Transplant International, 1996
- Biliary strictures in liver transplant recipients: treatment with metal stents.Radiology, 1996
- Biliary strictures after liver transplantation: Clinical picture, correlates and outcomesJournal of Gastroenterology and Hepatology, 1996
- Biliary Tract Complications After Liver TransplantationArchives of Surgery, 1995
- The Incidence, Timing, and Management of Biliary Tract Complications After Orthotopic Liver TransplantationAnnals of Surgery, 1994
- Increased Bile Duct Complications in Liver Transplantation Across the ABO BarrierAnnals of Surgery, 1993
- Biliary Strictures Complicating Liver Transplantation Incidence, Pathogenesis, Management, and OutcomeAnnals of Surgery, 1992
- Management of biliary complications after liver transplantationThe American Journal of Surgery, 1992
- Biliary Strictures in Hepatic TransplantationJournal of Vascular and Interventional Radiology, 1991