Diagnostic and interventional radiology (Ankara, Turkey) · 2025
The safety and efficacy of the percutaneous balloon-expandable biodegradable magnesium biliary stents in patients with liver transplant.
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Kutlu Ramazan, Dağ Nurullah, Saparbekov Eldiiar
Аннотация
PURPOSE: This study aims to present our institutional experience with the use of percutaneous balloon-expandable biodegradable magnesium biliary stents (MBS) in the treatment of benign, refractory anastomotic strictures (AS), where initial percutaneous or endoscopic approaches fail or are ineffective, after liver transplantation (LT).
METHODS: In this retrospective single-center study, 13 patients with clinically refractory AS who underwent MBS placement between July 2021 and August 2024 were evaluated. Statistical analyses included Kaplan-Meier survival analysis for patency and Spearman's correlation for recurrence risk. Primary outcomes included stricture recurrence and time to reintervention during follow-up.
RESULTS: The median age of patients was 35 years [interquartile range (IQR): 22-48], and 11 were male (85%). Living donor LT was performed in 12 (92%). The MBS were placed at a median of 8 months post-transplant (IQR: 5-44), with a technical success in all cases (100%). Before MBS placement, patients underwent a median of one endoscopic retrograde cholangiopancreatography (IQR: 0-3) and three percutaneous transhepatic biliary drainage procedures (IQR: 1-8). The median follow-up was 25 months (IQR: 15-33). The MBS patency rates were 93%, 85%, and 67% at 6, 12, and 24 months, respectively. Stricture recurrence occurred at a median of 30 months post-placement (95% confidence interval: 23.6-36.3). A moderate positive correlation was observed between the number of pre-stent interventions and recurrence risk (rho: 0.582, P = 0.023). Post-procedural complications (cholangitis) occurred in 1 patient.
CONCLUSION: Balloon-expandable biodegradable MBS may provide a safe and effective treatment for refractory AS following LT. Early placement of MBS, particularly after fewer prior interventions, appears to be associated with improved patency and longer stricture-free survival.
CLINICAL SIGNIFICANCE: Early use of biodegradable magnesium stents after LT may reduce the need for multiple interventions and improve long-term biliary patency.
METHODS: In this retrospective single-center study, 13 patients with clinically refractory AS who underwent MBS placement between July 2021 and August 2024 were evaluated. Statistical analyses included Kaplan-Meier survival analysis for patency and Spearman's correlation for recurrence risk. Primary outcomes included stricture recurrence and time to reintervention during follow-up.
RESULTS: The median age of patients was 35 years [interquartile range (IQR): 22-48], and 11 were male (85%). Living donor LT was performed in 12 (92%). The MBS were placed at a median of 8 months post-transplant (IQR: 5-44), with a technical success in all cases (100%). Before MBS placement, patients underwent a median of one endoscopic retrograde cholangiopancreatography (IQR: 0-3) and three percutaneous transhepatic biliary drainage procedures (IQR: 1-8). The median follow-up was 25 months (IQR: 15-33). The MBS patency rates were 93%, 85%, and 67% at 6, 12, and 24 months, respectively. Stricture recurrence occurred at a median of 30 months post-placement (95% confidence interval: 23.6-36.3). A moderate positive correlation was observed between the number of pre-stent interventions and recurrence risk (rho: 0.582, P = 0.023). Post-procedural complications (cholangitis) occurred in 1 patient.
CONCLUSION: Balloon-expandable biodegradable MBS may provide a safe and effective treatment for refractory AS following LT. Early placement of MBS, particularly after fewer prior interventions, appears to be associated with improved patency and longer stricture-free survival.
CLINICAL SIGNIFICANCE: Early use of biodegradable magnesium stents after LT may reduce the need for multiple interventions and improve long-term biliary patency.