Treatment of refractory benign biliary stenoses in liver transplant patients by placement and retrieval of a temporary stent-graft: Work in progress

PURPOSE: To evaluate patency of refractory benign biliary strictures in Liv er transplant patients treated with retrievable stent-grafts. MATERIALS AND METHODS: Eight male liver transplant patients who ranged in a ge from 42 to 52 years developed nine symptomatic biliary strictures (intra hepatic left duct, 1; hilar, 2; anastomotic, 6). These strictures had recur red despite multiple previous attempts of treatment (n = 33), including ang ioplasty (n = 27), surgery (n 1), atherectomy (n = 1), metallic stent (n = 1), and prolonged catheter drainage (n = 3). As an alternative method of tr eatment for these refractory biliary strictures, transhepatic placement of expanded polytetrafluoroethylene stent-grafts across the strictures was per formed through 10-F sheaths. In total, 14 stent-grafts were placed to treat the nine lesions, and nine of these stent-grafts were subsequently retriev ed through 12-16 F sheaths. RESULTS: Stent-grafts were deployed successfully. Delayed migrations in two patients required additional stent-graft placement. One patient died of pn eumonia 1 month after stent-graft placement; the remaining seven patients h ad stent-grafts successfully removed at 3-10 months (mean, 5.6 months). Nin e intended stent-graft retrievals were performed successfully, with two req uiring use of elongated forceps. Immediately after treatment, all stricture s were widely patent. Five to 6 months after stent-graft removal in these s even patients, significant strictures recurred in four of eight lesions (50 %). One patient underwent surgical revision. At 6-29 months (mean, 12 month s) after stent-graft removal, the remaining six patients were without clini cal or laboratory evidence of biliary obstruction, despite three patients w ith significant recurrent strictures. CONCLUSION: Temporary stent-graft placement for treatment of benign biliary strictures in liver transplant patients is technically feasible. Longer fo llow-up with larger patient series is necessary to assess effectiveness and possible broader applications.