Percutaneous Transhepatic Radiologic Intervention of Biliary Complications following Liver Transplantation: A Single-center Experience

Abstract

Background: Biliary complications are the leading cause of morbidity and mortality in patients undergo¬ing Liver Transplantation (LT). Post-biliary transplantation strictures (BSs) are a severe problem with a high risk of graft failure. However, management of these BSs has remained controversial, and consid¬erable variability has been reported in Percutaneous Transhepatic Radiological Interventions (PTRIs) related to broad differences in technical procedures.

Objective: This study aimed to evaluate the efficacy of percutaneous treatments in managing post-LT BSs in a center in Shiraz.

Methods: PTRIs including balloon dilatation, metallic stent, and internal or internal-external hand-made plastic stent insertion were done for 34 transplanted patients with BSs referring to the Interventional Radiology Unit of Shiraz Namazi Hospital. Technical success rate, patency rates, and complications were evaluated.

Results: The. In this study, 31 strictures were successfully treated without any significant difference between the anastomotic and non-anastomotic types of stricture (success rate: 91.2%). Based on the results, 12- , 24-, and 36-month primary patency rates were 90.1%, 84.5%, and 76.8%, respectively. The secondary patency rate was 100% at 12 and 24 months and 93.3% at 36 and 60 months. The rate of minor complica¬tions (mild cholangitis and hemobilia) was 6.4%, and no major complications were detected.

Conclusion: According to the findings, PTRI is an effective method for treating anastomotic and non-anas- tomotic strictures with a high success rate and low complications.

Keywords: Biliary stricture; Liver transplant; Percutaneous transhepatic radiologic intervention.

Figure 1

Internal plastic stent. (a) Percutaneous transhepatic cholangiography showed biliary dilatation due to post-transplantation anastomotic stricture. (b) Balloon dilatation of the stricture site. (c) Hand-made internal plastic stent deployed properly. The black arrow shows the mentioned handmade pore and the white arrow points to the sharp tip of the curved end of the drainage tube that was cut and inserted to reduce duct traumatization on the entrance.

Figure 2

Internal-external plastic stent. Balloon dilatation of the stricture sites at (a) the proximal part and (b) the distal part of the common bile duct (c) with subsequent internal-external plastic stent insertion.

Figure 3

Patient classification according to the PTRi success and approach after balloon dilation, number of complication (C) and recurrence (R), mean primary and secondary patency in each group. PTRi= percutaneous transhepatic radiologic intervention, #C= number of cases with complication after PTRi, #R= number of cases with recurrence after PTRi, MPP= mean primary patency, MSP=mean secondary patency