Biodegradable stents for biliary strictures after pediatric liver transplantation: a multicenter retrospective study

Category	Detail
Condition	Benign biliary strictures after pediatric liver transplantation
Key Mechanisms	Use of biodegradable polydioxanone stents to maintain biliary patency and reduce stricture recurrence
Target Population	Pediatric patients with biliary strictures post-liver transplantation
Care Setting	Specialized pediatric liver transplant centers with interventional radiology capabilities

Biliary strictures are common complications after pediatric liver transplantation, especially with Roux-en-Y hepaticojejunostomy reconstruction.
Percutaneous transhepatic cholangiography (PTC) with bilioplasty and drainage is standard but has limitations including prolonged drainage and infection risk.
Biodegradable stents offer a promising alternative, potentially reducing the need for prolonged external drainage and multiple interventions.

Diagnosis of biliary strictures is based on cholangiography findings via PTC.
Strictures are classified as anastomotic or intrahepatic and by length (< or ≥ 10 mm).

Initial management includes PTC with bilioplasty and internal-external biliary drainage.
Biodegradable polydioxanone stents (ELLA-BD THP) are considered for patients with residual/recoil strictures after bilioplasty or poor tolerance to drainage.
Stent size should be at least equal to the maximum balloon size used during bilioplasty.
Treatment decisions are individualized and made by multidisciplinary teams.

Follow-up includes monitoring for stricture recurrence, complications, and stent feasibility.
Minimum follow-up duration of 6 months is recommended to assess outcomes.

Prolonged internal-external biliary drainage increases infection risk and hospital readmissions.
Multiple interventions increase ionizing radiation exposure.
Use of biodegradable stents requires regulatory authorization and informed consent due to lack of FDA or CE clearance.

102 pediatric patients with benign biliary strictures post-liver transplantation treated with biodegradable stents

Biodegradable stents were feasible and safe with potential to reduce stricture recurrence and complications associated with prolonged drainage.

Employ multidisciplinary team discussions to individualize stent implantation decisions.
Use sonographic guidance and standard interventional techniques for PTC and stent placement under monitored anesthesia.
Administer prophylactic antibiotics prior to procedures to reduce infection risk.
Ensure detailed informed consent due to off-label use of biodegradable stents.
Monitor patients closely post-procedure for stricture recurrence and complications.

Clinical Scorecard: Biodegradable Stents in Managing Biliary Strictures Following Pediatric Liver Transplantation: A Retrospective Multicenter Analysis