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 l iver transplantation. PATIENTS AND METHODS: Twenty-four patients with intrahepatic biliary strictures after liver transplantation were treat ed with metallic stents, Eleven had undergone prior unsuccessful percu taneous balloon dilation, Successful stent deployment occurred in all subjects, Gianturco, Wallstents, and Palmaz stents were used, Follow-u p was obtained in all 24 patients. RESULTS: Initial technical success was obtained in all 24 patients, In 11 patients, long-term primary, pr imary assisted, or secondary stent patency was achieved with follow-up ranging from 17 to 58 months, Ten patients died or underwent retransp lantation within 14 months for reasons unrelated to their stents, In t hree patients, stent placements failed because of stent obstructions t hat were refractory to attempts at secondary patency, By life-table an alysis, cumulative primary, primary assisted, and secondary patency ra tes were 50%, 61%, and 80%, respectively, at 18 months. CONCLUSION: Me tallic biliary stents offer promising results for intrahepatic strictu res in the posttransplant patient, particularly in patients with wides pread strictures, Stents can become partially or totally obstructed du e to sludge and debris, but patency can often be restored with additio nal interventional techniques.