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Percutaneous Treatment of Biliary Strictures After Pediatric Liver Transplantation

BACKGROUND: Biliary strictures (BS) are frequent after pediatric liver transplantation (LTx) and in spite of ongoing progress, they remain a significant cause of morbidity. In children, the majority of reconstruction is hepatico-jejunal anastomosis (HJA). The aim of this study was to analyze our exp...

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Autores principales: Czubkowski, Piotr, Markiewicz-Kijewska, Małgorzata, Janiszewski, Kazimierz, Rurarz, Małgorzata, Kaliciński, Piotr, Jarzębicka, Dorota, Pertkiewicz, Jan, Kamińska, Diana, Jankowska, Irena, Teisseyre, Mikołaj, Szymczak, Marek, Pawłowska, Joanna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299781/
https://www.ncbi.nlm.nih.gov/pubmed/30531688
http://dx.doi.org/10.12659/AOT.910528
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author Czubkowski, Piotr
Markiewicz-Kijewska, Małgorzata
Janiszewski, Kazimierz
Rurarz, Małgorzata
Kaliciński, Piotr
Jarzębicka, Dorota
Pertkiewicz, Jan
Kamińska, Diana
Jankowska, Irena
Teisseyre, Mikołaj
Szymczak, Marek
Pawłowska, Joanna
author_facet Czubkowski, Piotr
Markiewicz-Kijewska, Małgorzata
Janiszewski, Kazimierz
Rurarz, Małgorzata
Kaliciński, Piotr
Jarzębicka, Dorota
Pertkiewicz, Jan
Kamińska, Diana
Jankowska, Irena
Teisseyre, Mikołaj
Szymczak, Marek
Pawłowska, Joanna
author_sort Czubkowski, Piotr
collection PubMed
description BACKGROUND: Biliary strictures (BS) are frequent after pediatric liver transplantation (LTx) and in spite of ongoing progress, they remain a significant cause of morbidity. In children, the majority of reconstruction is hepatico-jejunal anastomosis (HJA). The aim of this study was to analyze our experience in percutaneous transhepatic treatment of BS. MATERIAL/METHODS: Between 1998 and 2014, 589 (269 living donor) pediatric LTx were performed in our institution. We retrospectively reviewed clinical data of patients with HJA who developed BS and who underwent percutaneous transhepatic biliary drainage (PTBD). RESULTS: Out of 400 patients with HJA, 35 patients developed BS. There were 27 cases (77%) of anastomotic BS (ABS) and 8 cases (23%) of multilevel BS (MBS). Ninety-two PTBD sessions (2.5 per patient) were performed, with successful outcomes in 20 cases (57%). Fifteen patients, after failed PTBD, underwent surgery which was successful in 11 cases. Overall good outcomes were achieved in 31 cases (88.5%). The most common complication of PTBD was cholangitis which occurred in 5.4% of the cases. We did not find any risk factors for PTBD failure, except for treatment occurring before 2007. CONCLUSIONS: Percutaneous treatment is effective and safe in BS and is recommended as a first-line approach. The majority of patients in our study required multiple interventions, however, the overall risk of complications was low. Surgery is essential in selected cases and always should be considered if PTBD fails.
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spelling pubmed-62997812019-01-14 Percutaneous Treatment of Biliary Strictures After Pediatric Liver Transplantation Czubkowski, Piotr Markiewicz-Kijewska, Małgorzata Janiszewski, Kazimierz Rurarz, Małgorzata Kaliciński, Piotr Jarzębicka, Dorota Pertkiewicz, Jan Kamińska, Diana Jankowska, Irena Teisseyre, Mikołaj Szymczak, Marek Pawłowska, Joanna Ann Transplant Original Paper BACKGROUND: Biliary strictures (BS) are frequent after pediatric liver transplantation (LTx) and in spite of ongoing progress, they remain a significant cause of morbidity. In children, the majority of reconstruction is hepatico-jejunal anastomosis (HJA). The aim of this study was to analyze our experience in percutaneous transhepatic treatment of BS. MATERIAL/METHODS: Between 1998 and 2014, 589 (269 living donor) pediatric LTx were performed in our institution. We retrospectively reviewed clinical data of patients with HJA who developed BS and who underwent percutaneous transhepatic biliary drainage (PTBD). RESULTS: Out of 400 patients with HJA, 35 patients developed BS. There were 27 cases (77%) of anastomotic BS (ABS) and 8 cases (23%) of multilevel BS (MBS). Ninety-two PTBD sessions (2.5 per patient) were performed, with successful outcomes in 20 cases (57%). Fifteen patients, after failed PTBD, underwent surgery which was successful in 11 cases. Overall good outcomes were achieved in 31 cases (88.5%). The most common complication of PTBD was cholangitis which occurred in 5.4% of the cases. We did not find any risk factors for PTBD failure, except for treatment occurring before 2007. CONCLUSIONS: Percutaneous treatment is effective and safe in BS and is recommended as a first-line approach. The majority of patients in our study required multiple interventions, however, the overall risk of complications was low. Surgery is essential in selected cases and always should be considered if PTBD fails. International Scientific Literature, Inc. 2018-12-11 /pmc/articles/PMC6299781/ /pubmed/30531688 http://dx.doi.org/10.12659/AOT.910528 Text en © Ann Transplant, 2018 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Original Paper
Czubkowski, Piotr
Markiewicz-Kijewska, Małgorzata
Janiszewski, Kazimierz
Rurarz, Małgorzata
Kaliciński, Piotr
Jarzębicka, Dorota
Pertkiewicz, Jan
Kamińska, Diana
Jankowska, Irena
Teisseyre, Mikołaj
Szymczak, Marek
Pawłowska, Joanna
Percutaneous Treatment of Biliary Strictures After Pediatric Liver Transplantation
title Percutaneous Treatment of Biliary Strictures After Pediatric Liver Transplantation
title_full Percutaneous Treatment of Biliary Strictures After Pediatric Liver Transplantation
title_fullStr Percutaneous Treatment of Biliary Strictures After Pediatric Liver Transplantation
title_full_unstemmed Percutaneous Treatment of Biliary Strictures After Pediatric Liver Transplantation
title_short Percutaneous Treatment of Biliary Strictures After Pediatric Liver Transplantation
title_sort percutaneous treatment of biliary strictures after pediatric liver transplantation
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299781/
https://www.ncbi.nlm.nih.gov/pubmed/30531688
http://dx.doi.org/10.12659/AOT.910528
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