Improved Outcomes from Prolonged Percutaneous Biliary Drainage in Pediatric Patients with Biliary Stenosis after Liver Transplantation.

Abstract

Purpose: To evaluate patency rates, outcomes of percutaneous transhepatic biliary drainage (PTBD), and predictors of stenosis recurrence.

Materials and methods: A retrospective analysis of 47 PTBDs in 40 pediatric patients after pLT (2009-2019) was performed. Six patients underwent repeated PTBD for recurrent biliary strictures. Kaplan-Meier, log-rank, and Cox regression analyses evaluated patency and influencing factors. Management followed institutional protocols with drain upsizing every 6-8 weeks. The median age and weight were 1.8 years (interquartile range [IQR], 0.8-8.2) and 9.9 kg (IQR, 7.5-19.6), respectively.

Results: The median interval from pLT to PTBD was 122 days (IQR, 55-626). The primary patency rates were 89.4% at 1 year and 86.3% at 5 years, with 15% restenosis after a median of 8.5 months. Repeat PTBD achieved patency rates of 100% at 1 year and 83.3% at 5 years (exploratory). Patency declined with dwell times of <5 months (P = .015), biliary leaks limited to the period before or during PTBD (post-PTBD leaks showed no association), hepaticojejunostomy revision, complex portal-vein reconstruction, and low- to moderate-grade hepatic artery stenosis. Longer dwell time reduced recurrence risk (hazard ratio, 0.52; 95% confidence interval, 0.30-0.89). Elevated alkaline phosphatase, bilirubin, gamma-glutamyl transferase, and aspartate aminotransferase levels were predictive of recurrence (P < .05).

Conclusions: PTBD ≥5 months improved biliary patency and reduced restenosis risk. Shorter durations increased recurrence risk. Outcomes depended on PTBD duration, vascular status, bile leaks, and surgical complexity. Laboratory changes during and after therapy may have indicated recurrent stenosis.