Journal List > J Korean Soc Radiol > v.68(4) > 1087240

Park, Byun, Kim, Kim, Hwang, Kim, Choi, and Park: Percutaneous Balloon Dilatation and Catheter Maintenance Method in the Patients with Biliary Strictures after Living Donor Liver Transplantation

Abstract

Purpose

The aim of this study was to evaluate the therapeutic efficacy of the percutaneous balloon dilatation and catheter maintenance (BDCM) method for postoperative biliary strictures following living donor liver transplantation (LDLT).

Materials and Methods

Eighteen patients (14 duct-to-duct anastomosis and 4 hepaticojejunostomy) with post-LDLT biliary stricture were treated by the percutaneous BDCM method. A good response was defined as residual stricture over 3.5 mm after repetitive BDCM and refractory response as residual stricture below 3.5 mm. If they demonstrated good results on follow-up studies after catheter withdrawal, all the patients quit the therapy. We evaluated the technical and clinical success rates, major complication rate, mean total procedure time and mean follow-up duration.

Results

The percutaneous BDCM method was technically successful without major complication. Nine patients improved biliary stricture (good response, mean 5.5 mm), and the other 9 patients showed residual stricture with the diameter below 3.5 mm (refractory response, mean 2.5 mm). However, all the patients were improved clinically without significant complication. The total procedure time was 1-15 months (mean 7.3 months) and follow-up duration was 6-54 months (mean 24 months).

Conclusion

The percutaneous BDCM method for post-LDLT biliary strictures was an effective therapy even in the patients showing a refractory response. It seemed that total procedure time could be reduced if the response was determined earlier.

References

1. Wilson BJ, Marsh JW, Makowka L, Stieber AC, Koneru B, Todo S, et al. Biliary tract complications in orthotopic adult liver transplantation. Am J Surg. 1989. 158:68–70.
2. Thuluvath PJ, Pfau PR, Kimmey MB, Ginsberg GG. Biliary complications after liver transplantation: the role of endoscopy. Endoscopy. 2005. 37:857–863.
3. Stratta RJ, Wood RP, Langnas AN, Hollins RR, Bruder KJ, Donovan JP, et al. Diagnosis and treatment of biliary tract complications after orthotopic liver transplantation. Surgery. 1989. 106:675–683. discussion 683-684.
4. Scotté M, Dousset B, Calmus Y, Conti F, Houssin D, Chapuis Y. The influence of cold ischemia time on biliary complications following liver transplantation. J Hepatol. 1994. 21:340–346.
5. Greif F, Bronsther OL, Van Thiel DH, Casavilla A, Iwatsuki S, Tzakis A, et al. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg. 1994. 219:40–45.
6. Schwarzenberg SJ, Sharp HL, Payne WD, Hunter DW, Bjarnason H, Humar A, et al. Biliary stricture in living-related donor liver transplantation: management with balloon dilation. Pediatr Transplant. 2002. 6:132–135.
7. Zoepf T, Maldonado-Lopez EJ, Hilgard P, Schlaak J, Malago M, Broelsch CE, et al. Endoscopic therapy of posttransplant biliary stenoses after right-sided adult living donor liver transplantation. Clin Gastroenterol Hepatol. 2005. 3:1144–1149.
8. Egawa H, Inomata Y, Uemoto S, Asonuma K, Kiuchi T, Fujita S, et al. Biliary anastomotic complications in 400 living related liver transplantations. World J Surg. 2001. 25:1300–1307.
9. Fondevila C, Ghobrial RM, Fuster J, Bombuy E, García-Valdecasas JC, Busuttil RW. Biliary complications after adult living donor liver transplantation. Transplant Proc. 2003. 35:1902–1903.
10. Testa G, Malagó M, Valentín-Gamazo C, Lindell G, Broelsch CE. Biliary anastomosis in living related liver transplantation using the right liver lobe: techniques and complications. Liver Transpl. 2000. 6:710–714.
11. Colonna JO 2nd, Shaked A, Gomes AS, Colquhoun SD, Jurim O, McDiarmid SV, et al. Biliary strictures complicating liver transplantation. Incidence, pathogenesis, management, and outcome. Ann Surg. 1992. 216:344–350. discussion 350-352.
12. D'Alessandro AM, Kalayoglu M, Pirsch JD, Sollinger HW, Reed A, Knechtle SJ, et al. Biliary tract complications after orthotopic liver transplantation. Transplant Proc. 1991. 23:1956.
13. Neuhaus P, Blumhardt G, Bechstein WO, Steffen R, Platz KP, Keck H. Technique and results of biliary reconstruction using side-to-side choledochocholedochostomy in 300 orthotopic liver transplants. Ann Surg. 1994. 219:426–434.
14. Rossi G, Lucianetti A, Gridelli B, Colledan M, Caccamo L, Albani AP, et al. Biliary tract complications in 224 orthotopic liver transplantations. Transplant Proc. 1994. 26:3626–3628.
15. Verran DJ, Asfar SK, Ghent CN, Grant DR, Wall WJ. Biliary reconstruction without T tubes or stents in liver transplantation: report of 502 consecutive cases. Liver Transpl Surg. 1997. 3:365–373.
16. Hisatsune H, Yazumi S, Egawa H, Asada M, Hasegawa K, Kodama Y, et al. Endoscopic management of biliary strictures after duct-to-duct biliary reconstruction in right-lobe living-donor liver transplantation. Transplantation. 2003. 76:810–815.
17. Yazumi S, Yoshimoto T, Hisatsune H, Hasegawa K, Kida M, Tada S, et al. Endoscopic treatment of biliary complications after right-lobe living-donor liver transplantation with duct-to-duct biliary anastomosis. J Hepatobiliary Pancreat Surg. 2006. 13:502–510.
18. Seo JK, Ryu JK, Lee SH, Park JK, Yang KY, Kim YT, et al. Endoscopic treatment for biliary stricture after adult living donor liver transplantation. Liver Transpl. 2009. 15:369–380.
19. Jeffrey GP, Brind AM, Ormonde DG, Frazer CK, Ferguson J, Bell R, et al. Management of biliary tract complications following liver transplantation. Aust N Z J Surg. 1999. 69:717–722.
20. Zajko AB, Sheng R, Zetti GM, Madariaga JR, Bron KM. Transhepatic balloon dilation of biliary strictures in liver transplant patients: a 10-year experience. J Vasc Interv Radiol. 1995. 6:79–83.
21. Choo SW, Shin SW, Do YS, Liu WC, Park KB, Sung YM, et al. The balloon dilatation and large profile catheter maintenance method for the management of the bile duct stricture following liver transplantation. Korean J Radiol. 2006. 7:41–49.
22. Ko GY, Sung KB, Yoon HK, Kim KR, Gwon DI, Lee SG. Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation. Liver Transpl. 2008. 14:1323–1332.
23. Qian YB, Liu CL, Lo CM, Fan ST. Risk factors for biliary complications after liver transplantation. Arch Surg. 2004. 139:1101–1105.
24. Sampietro R, Goffette P, Danse E, De Reyck C, Roggen F, Ciccarelli O, et al. Extension of the adult hepatic allograft pool using split liver transplantation. Acta Gastroenterol Belg. 2005. 68:369–375.
25. Spada M, Cescon M, Aluffi A, Zambelli M, Guizzetti M, Lucianetti A, et al. Use of extended right grafts from in situ split livers in adult liver transplantation: a comparison with whole-liver transplants. Transplant Proc. 2005. 37:1164–1166.
26. Fan ST, Lo CM, Liu CL, Tso WK, Wong J. Biliary reconstruction and complications of right lobe live donor liver transplantation. Ann Surg. 2002. 236:676–683.
27. Wachs ME, Bak TE, Karrer FM, Everson GT, Shrestha R, Trouillot TE, et al. Adult living donor liver transplantation using a right hepatic lobe. Transplantation. 1998. 66:1313–1316.
28. Saad WE, Davies MG, Saad NE, Waldman DL, Sahler LG, Lee DE, et al. Transhepatic dilation of anastomotic biliary strictures in liver transplant recipients with use of a combined cutting and conventional balloon protocol: technical safety and efficacy. J Vasc Interv Radiol. 2006. 17:837–843.
29. Petersen BD, Timmermans HA, Uchida BT, Rabkin JM, Keller FS. Treatment of refractory benign biliary stenoses in liver transplant patients by placement and retrieval of a temporary stent-graft: work in progress. J Vasc Interv Radiol. 2000. 11:919–929.
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