Percutaneous transhepatic cholangiography and drainage for biliary strictures after pediatric liver transplantation.

OBJECTIVES

Biliary strictures (BS) remain frequent after pediatric liver transplantation (pLT) and best management practices are still lacking. This study systematically assesses efficacy of stricture treatment by percutaneous transhepatic cholangiography and drainage (PTCD).

METHODS

Online databases were searched for studies on PTCD treatment of BS after pLT from the year 2000 to 2024. Efficacy and safety profile of PTCD were analyzed. Influence of various risk factors on outcome parameters was compared by meta-regression.

RESULTS

Twenty-seven observational studies with 802 patients undergoing PTCD for BS met the inclusion criteria. Incidence of BS was 13.1% (95% confidence interval [CI]: 10.3-16.1) in 6543 patients reported who underwent pLT between 1989 and 2020. Overall efficacy of PTCD to achieve stricture resolution was 78.3% (95% CI: 66.5-80.4). Drainage duration longer or shorter than 109.1 days did not impact on achievement of resolution with efficacies of 76.5% (95% CI: 65.4-86.2) in short versus 75.1% (95% CI: 61.9-86.5, p = 0.87) in long drainage. Overall recurrence rate after stricture resolution was 16.0% (95% CI: 7.5-26.3). Drainage duration longer or shorter than 109.1 days did not affect recurrence rate which was 17.4% (95% CI: 3.3-37.3) in short versus 20.9% (95% CI: 14.0-28.5, p = 0.68) in long drainage duration. Overall rate of procedure-related complications was 9.9% (95% CI: 2.6-20.0, p = 0.99) and was not influenced by drainage duration.

CONCLUSIONS

PTCD is efficient to treat BS after pLT. Drainage time does not impact efficacy, recurrence rate, and complication rate. Randomized trials are necessary to determine the best treatment protocol concerning drainage duration and intervals between interventions.