Department of Radiology, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Eur Radiol. 2022 Apr;32(4):2414-2425. doi: 10.1007/s00330-021-08373-z. Epub 2022 Jan 22.
To investigate clinical outcomes of percutaneous transhepatic treatment for biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation (LDLT).
This retrospective study examined baseline characteristics, procedural details, clinical outcomes, drainage catheter removal rate within 8 months, and recurrence after catheter removal using patients' medical records and images. Risk factors for failure of drainage catheter removal within 8 months and recurrence of biliary stricture after drainage catheter removal were assessed via univariable and multivariable analyses.
A total of 112 patients (53.4 ± 8.79 years, 91 men) were evaluated. Multiple drainage catheters were placed in 75 patients (70.0%). Drainage catheters were successfully removed in 107 patients (95.5%). Failure of drainage catheter removal within 8 months was associated with hepatic artery complications (p = 0.034) and strictures requiring alternative passage techniques (p = 0.034). The cumulative primary patency rates after drainage catheter removal at 1, 2, 3, and 5 years were 85.4%, 79.8%, 75.8%, and 68.4%, respectively. Recurrence of biliary stricture was associated with the presence of an untreated isolated sectoral duct (aHR, 3.632; 95% CI, 1.086-12.150, p = 0.037) and with concurrent bile leaks (aHR, 2.475; 95% CI, 1.090-5.621, p = 0.031).
Percutaneous transhepatic treatment was effective for the treatment of biliary strictures after duct-to-duct biliary anastomosis in LDLT. Multiple drainage catheter maintenance was needed because multiple strictures often occurred in these patients.
• Percutaneous transhepatic treatments are useful and effective for the treatment of biliary stricture after duct-to-duct biliary anastomosis in living donor liver transplantation (LDLT), although an endoscopic approach is available for this type of reconstruction. • Multiple drainage catheters were frequently placed in these patients because of multiple complex strictures. • We found that recurrence after drainage catheter removal was associated with isolation of the sectoral duct and with concurrent bile leaks.
探讨经皮经肝胆道引流术（PTBD）治疗活体肝移植（LDLT）后胆肠吻合口胆管狭窄的临床效果。
本回顾性研究通过查阅患者病历和影像学资料，分析了患者的基本特征、操作细节、临床效果、8 个月内引流管拔除率以及拔管后复发情况。通过单变量和多变量分析评估了 8 个月内引流管拔除失败和拔管后胆管狭窄复发的危险因素。
共评估了 112 例患者（53.4±8.79 岁，91 例男性）。75 例患者（70.0%）放置了多个引流管。107 例（95.5%）患者成功拔除引流管。8 个月内引流管拔除失败与肝动脉并发症（p=0.034）和需要替代通道技术的狭窄有关（p=0.034）。引流管拔除后 1、2、3、5 年的原发性通畅率分别为 85.4%、79.8%、75.8%和 68.4%。胆管狭窄复发与未治疗的孤立性肝段胆管（aHR，3.632；95%CI，1.086-12.150，p=0.037）和并发胆漏（aHR，2.475；95%CI，1.090-5.621，p=0.031）有关。
PTBD 治疗 LDLT 后胆肠吻合口胆管狭窄有效，由于这些患者常发生多处狭窄，需要维持多个引流管。
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