Biliary reconstruction with biodegradable stent in pediatric liver transplantation: long-term follow-up.

Introduction and Objectives

The biliary complications can limit the survival of both the graft and the patient in the liver transplant (LT). Biliary strictures represent 80% of cases, could appear early; <6 months or late >6 months post-transplant. To present our experience in the use of the biodegradable stent for biliary reconstruction in LT

Materials and Patients

Prospective, non-randomized study, in patients undergoing liver transplantation from a living donor period from February 2023 to 2024 with the use of a biodegradable stent, the biochemical variables of liver function, as well as radio imaging studies will be recorded to evaluate the presence or no biliary complications during the study. The characteristics of the stend were standardized based on the weight and measurements of the patient and native bile duct.

Results

6 patients met the requirements to be included in the study, 6 stent placements were performed in 6 transplants, all of them were female, the diagnosis prior to transplantation were biliary atresia (BA) 2, hepatoblastoma 2, and acute liver failure (ALF) 2, with a median age of 22.5 months SD +13.2 months and a median of weight 10.7 kg SD +3.8 kg. (image 1). In 4 patients, left bilio-hepatic anastomosis was performed and in two patients, left hepatic anastomosis was performed toward roux. The degradation was demonstrable with a median of 5.3 months with SD 1.2 after placement. Follow-up was carried out for an average of 9.3 months with a minimum of 4 months and a maximum of 14 months. At the time of the study, all patients show adequate tolerance with no evidence of post-transplant biliary complications requiring biliary exploration or reconstruction. (image 2).

Conclusions

The anatomical characteristics of the stend prevent obstruction or stenosis at the level of the biliary anastomosis, corroborated by imaging studies, laboratory results and clinical evolution throughout the follow-up of our study. We present the first world report with long-term follow-up with the use of a biodegradable device in pediatric patients with an open approach in living donor.

Ethical statement: This study completes the ethical statuses established by our hospital ethics committee.

Declaration of interests: None.

Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors..

1.- Follow up of biodegrable stend in six patients with liver transplantation

Age at time of transplant *	Weight at time of transplant **	Reason for transplant	Follow up until now *	Presence of the stend on X-ray *	Dilation of the bile duct in US
16 m	9 kg	BA	14 m	6 m	no
21 m	10.9 kg	Hepatoblastoma	14 m	6 m	no
24 m	10.5 kg	Hepatoblastoma	12 m	6 m	no
19 m	7.5 kg	BA	7 m	6 m	no
52 m	15.5 kg	ALF	5m	5 m	no
32 m	17.5 kg	ALF	4 m	2 m	no

* months ** kilograms BA biliary atresia ALF acute liver failure