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Percutaneous Balloon Dilatation for Hepaticojejunostomy Stricture Following Paediatric Liver Transplantation: Long-Term Results of an Institutional “Three-Session” Protocol

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Abstract

Purpose

The aim of this study was to report the long-term results of an institutional protocol of percutaneous biliary balloon dilatation (PBBD) on paediatric patients with benign anastomotic stricture after liver transplantation. As a secondary objective, we evaluated risk factors associated with post-treatment re-stricture.

Materials and Methods

Fourteen paediatric, post-liver transplant patients with benign anastomotic stricture of Roux-en-Y hepaticojejunostomy were included. All patients underwent the same treatment protocol of three PBBD procedures with 15-day intervals. Clinical outcome was analysed using the Terblanche classification. Primary patency rate was assessed with the Kaplan–Meier test.

Results

All patients had an initial successful result (Terblanche grade, excellent/good) after PBBD. At the end of the follow-up time of 35.7 ± 21.1 months (CI95%, 23.5–47.9), 10 patients persisted with excellent/good grading, while the remaining 4 had re-stricture, all of the latter occurring within the first 19 months. Patency rate after percutaneous treatment at 1, 3, and 5 years were 85.7%, 70%, and 70%, respectively. History of major complication after liver transplantation was associated with 5 times higher risk of re-stricture, HR 5.48 [95% CI, 2.18–8.78], p = 0.018.

Conclusion

In paediatric patients with benign anastomotic stricture of hepaticojejunostomy after liver transplantation, the “Three-session” percutaneous biliary balloon dilatation protocol is associated with a high rate of long-term success. In this limited series, the history of post-liver transplant major complication, defined as complications requiring a reintervention under general anaesthesia or advanced life support, seems to be an independent risk factor for stricture recurrence.

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Funding

This study was not supported by any funding.

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Author notes

  1. Rocío Claudia Bruballa

    Present address: Division of Image Guided Minimally Invasive Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Authors and Affiliations

  1. Division of Image Guided Minimally Invasive Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Aldo Sebastián Oggero, Pablo Ezequiel Huespe & Sung Ho Hyon

  2. Division of Hepato Pancreatic Biliary Surgery and Liver Transplant Unit, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Martín de Santibañes, Rodrigo Sanchez Claria, Gustavo Boldrini, Daniel D’Agostino, Juan Pekolj & Eduardo de Santibañes

  3. Division of Paediatric Hepatology, Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Gustavo Boldrini & Daniel D’Agostino

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  1. Aldo Sebastián Oggero
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Oggero, A.S., Bruballa, R.C., Huespe, P.E. et al. Percutaneous Balloon Dilatation for Hepaticojejunostomy Stricture Following Paediatric Liver Transplantation: Long-Term Results of an Institutional “Three-Session” Protocol. Cardiovasc Intervent Radiol 45, 330–336 (2022). https://doi.org/10.1007/s00270-021-03000-2

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