Metallic stents for the treatment of intrahepatic biliary strictures after liver transplantation

PURPOSE: The authors report their results with use of metallic stents for the treatment of intrahepatic biliary strictures occurring after liver transplantation. PATIENTS AND METHODS: Twenty-four patients with intrahepatic biliary strictures after liver transplantation were treated with metallic stents, Eleven had undergone prior unsuccessful percutaneous balloon dilation, Successful stent deployment occurred in all subjects, Gianturco, Wallstents, and Palmaz stents were used, Follow-up was obtained in all 24 patients. RESULTS: Initial technical success was obtained in all 24 patients, In 11 patients, long-term primary, primary assisted, or secondary stent patency was achieved with follow-up ranging from 17 to 58 months, Ten patients died or underwent retransplantation within 14 months for reasons unrelated to their stents, In three patients, stent placements failed because of stent obstructions that were refractory to attempts at secondary patency, By life-table analysis, cumulative primary, primary assisted, and secondary patency rates were 50%, 61%, and 80%, respectively, at 18 months. CONCLUSION: Metallic biliary stents offer promising results for intrahepatic strictures in the posttransplant patient, particularly in patients with widespread strictures, Stents can become partially or totally obstructed due to sludge and debris, but patency can often be restored with additional interventional techniques.