P.131 Initial experience with biodegradable stents for treatment of anastomotic biliary strictures in a single paediatric liver transplant center
Saturday May 04, 2019 from 18:30 to 20:00
Exhibit-Poster Area
Presenter

Rayna Alamurova, Bulgaria

Clinical Fellow in Paediatric Hepatology

Children's Liver Unit

Leeds General Infirmary

Abstract

Initial experience with biodegradable stents for treatment of anastomotic biliary strictures in a single paediatric liver transplant center

Rayna Alamurova1, Eirini Kyrana1, Marumbo Mtegha1, Suzanne Davison1, Nasim Tahir2, Magdy Attia1, Sanjay Rajwal1.

1Children's Liver Unit, Leeds Children's Hospital, Leeds, United Kingdom; 2Interventional Radiology, Leeds Children's Hospital, Leeds, United Kingdom

Introduction: Biliary stricture is a common complication in post liver transplant children following use of split liver grafts (5-35%). The treatment options are repeat balloon dilatations, stent insertion and surgical repair.

Methods: Medical notes of 2 liver transplant recipients with biodegradable stents were reviewed. We have used polydioxanone stents ELLA-CS, s.r.o., Hradec Kralove, Czech Republic. The monofilament loses 50% of its breaking strenght after 3 weeks and is absorbed within 6 months. The strictures were diagnosed by abnormal liver tests, ultrasound (US), magnetic resonance cholangiopancreatography (MRCP) and subsequently confirmed by percutaneous transhepatic cholangiography (PTC). Patients were treated initially with balloon dilatations. Stent placement was done by percutaneous transhepatic access, without incidences. After repeat cholangiogram in 48h the covering external drain was removed.

Results:
Patient 1 - 2 years old girl with liver transplant for biliary atresia. 7 months post transplant had biliary dilatation on US and 5 months later developed septic episode. US and MRCP confirmed multiple liver abscesses. PTC revealed long anastomotic biliary stricture. Internal/external biliary drain was inserted. She required 3 PTC and balloon dilatations prior to the placement of biodegradable stent, size 5mm diameter and 30mm long. The stent was visible 1 month post insertion, intrahepatic bile ducts were slightly prominent, but not dilated, resolving abscesses visible. 3 months post insertion the stent was noted in situ. She remained clinically well.

Patient 2 - 13 years old boy with CD40 ligand deficiency, bone marrow transplant, needed liver transplant for sclerosing cholangitis secondary to cryptosporidiosis. He was noted to be cholestatic biochemically. 13 months post liver transplant US demonstrated dilated intrahepatic bile ducts, confirmed on MRCP. After PTC, which revealed tight stricture, unable to dilate, external drain was inserted. There were 3 more PTC and balloon dilatations, with internal/external drain left in situ, before the placement of biodegradable stent, size 6mm diameter and 40mm long. On the US 3 months post stent insertion there was no residual biliary dilatation, the stent was visible.

Conclusion: Percutaneous transhepatic placement of biodegradable stent is a promising treatment for anastomotic biliary strictures in paediatric liver transplant recipients but needs a close follow up.

References:

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