North American Biliary Stricture Management Strategies in Children After Liver Transplantation: A Multicenter Analysis From the Society of Pediatric Liver Transplantation (SPLIT) Registry.
North American Biliary Stricture Management Strategies in Children After Liver Transplantation: A Multicenter Analysis From the Society of Pediatric Liver Transplantation (SPLIT) Registry.
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北美儿童肝移植后胆道狭窄的处理策略：来自儿科肝移植协会 (SPLIT) 登记处的多中心分析。
DOI：
10.1002/lt.26379
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Soc
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文献类型：
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作者：
Valentino,PamelaL;Wang,Tianhao;Shabanova,Veronika;Ng,VickyLee;Bucuvalas,JohnC;Feldman,AmyG;Gonzalez-Peralta,ReginoP;Gupta,NitikaArora;Miloh,TamirA;Mohammad,Saeed;Pace,Erika;Sundaram,ShikhaS;Yazigi,NadaA;Soltys,Kyle;Soc
胆道狭窄影响4%-12%的儿童肝移植。如果不进行治疗，胆道狭窄可能会导致移植物丢失；然而，对于最佳治疗方案仍未达成共识。研究目标包括通过经皮肝穿胆管造影术(PTC)、内窥镜逆行胆胰管造影术(ERCP)或外科手术分析与胆道狭窄处理策略相关的结果。我们从儿科肝移植学会(SPLIT)登记中确定了患有胆道狭窄的儿童肝移植受者(2011-2016)，并从各个中心检索了影像、程序和手术报告。对PTC和ERCP的“最佳胆道预后”(OBO)进行亚分析，其定义为移植物存活率与狭窄消退，且无复发或手术。共有113名儿童在肝移植后100天(四分位数范围30-290)被诊断为狭窄，中位随访期为3.9年；81%为孤立吻合口狭窄。狭窄在101天内消退率为92%，以单纯吻合口狭窄最常见(96%)。20%的狭窄复发，更常见的是与肝动脉血栓有关(32%)。1年和3年患者和移植物存活率分别为99%和98%，94%和92%。在一项对79名接受PTC/ERCP治疗的肝外狭窄患者的亚组分析中，59%的患者在中位数为4个PTC后发生了OBO，75%的患者在中位数为3个ERCP后获得了OBO(P<；0.001)。在OBO患者中，ERCP患者连续手术的间隔时间(41，47，54，62，71天)长于PTC患者(27，31，36，41，48天；P<；0.001)。在所有的干预措施中，同种异体移植物的挽救都是成功的。狭窄消退率为92%，复发率为20%。在单纯吻合口狭窄和无肝动脉血栓形成的患者中，无复发的回复率最高。
Biliary strictures affect 4%‐12% of pediatric liver transplantations. Biliary strictures can contribute to graft loss if left untreated; however, there remains no consensus on the best course of treatment. Study objectives included analyses of outcomes associated with biliary stricture management strategies via percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP), or surgery. We identified pediatric liver transplantation recipients (2011‐2016) with biliary strictures from the Society of Pediatric Liver Transplantation (SPLIT) registry and retrieved imaging, procedural, and operative reports from individual centers. Subanalyses were performed to specifically evaluate PTC and ERCP for “optimal biliary outcome” (OBO), defined as graft survival with stricture resolution and without recurrence or surgery. A total of 113 children with a median follow‐up of 3.9 years had strictures diagnosed 100 days (interquartile range, 30‐290) after liver transplantation; 81% were isolated anastomotic strictures. Stricture resolution was achieved in 92% within 101 days, more frequently with isolated anastomotic strictures (96%). 20% of strictures recurred, more commonly in association with hepatic artery thrombosis (32%). Patient and graft survival at 1 and 3 years were 99% and 98% and 94% and 92%, respectively. In a subgroup analysis of 79 patients with extrahepatic strictures managed by PTC/ERCP, 59% achieved OBO following a median of 4 PTC, and 75% following a median of 3 ERCP (P< 0.001). Among patients with OBO, those with ERCP had longer time intervals between successive procedures (41, 47, 54, 62, 71 days) than for PTC (27, 31, 36, 41, 48 days;P< 0.001). Allograft salvage was successful across all interventions. Stricture resolution was achieved in 92%, with 20% risk of recurrence. Resolution without recurrence was highest in patients with isolated anastomotic strictures and without hepatic artery thrombosis.