Pediatric transplantation · 2026
Effectiveness and Safety of Endoscopic Retrograde Cholangiopancreatography for Post-Transplant Biliary Strictures in Children: Experience From Two Centers in Southern Iran.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Shahramian Iraj, Imanieh Mohammad Hadi, Haghighat Mahmood, Dehghani Seyed Mohsen, Honar Naser, Ataollahi Maryam, Malekhosseini Seyed Ali, Sivandzadeh Gholamreza, Ejtehadi Fardad, Niknam Ramin, Kazemi Kourosh, Hashemi Seyed Mohammad Amir
Аннотация
BACKGROUND: Biliary strictures are among the most frequent complications following pediatric liver transplantation and can compromise graft function if not promptly managed. Endoscopic retrograde cholangiopancreatography (ERCP) is increasingly recognized as a safe, minimally invasive first-line therapy, though pediatric data remain limited.
METHODS: We retrospectively reviewed children under 18 years who developed post-transplant biliary strictures between 2017 and 2025 at two tertiary centers in Shiraz, Iran. Demographic, clinical, and procedural data were analyzed. Procedural success was defined as restoration of bile flow, and overall patient outcomes were evaluated across all ERCP sessions.
RESULTS: Among 362 pediatric liver transplant recipients, 31 (8.5%) developed biliary strictures, and 27 met inclusion criteria (12 males, 15 females). A total of 87 ERCP sessions were performed, with an overall success rate of 70.4%. Six patients (22.2%) required percutaneous transhepatic biliary drainage, and two (7.4%) underwent surgical intervention. Serum ALT and ALP levels significantly decreased after ERCP (ALT: 123 to 46 U/L, p = 0.02; ALP: 767 to 568 U/L, p = 0.028; Wilcoxon signed-rank test), whereas total bilirubin changes were not significant. Complications occurred in 12.6% of procedures, mainly mild post-ERCP pancreatitis (6.9%), all managed conservatively.
CONCLUSIONS: ERCP is a safe and effective initial treatment for post-transplant biliary strictures in children. Complications are generally minor and manageable, supporting its role as a minimally invasive therapeutic option in pediatric liver transplant centers.
METHODS: We retrospectively reviewed children under 18 years who developed post-transplant biliary strictures between 2017 and 2025 at two tertiary centers in Shiraz, Iran. Demographic, clinical, and procedural data were analyzed. Procedural success was defined as restoration of bile flow, and overall patient outcomes were evaluated across all ERCP sessions.
RESULTS: Among 362 pediatric liver transplant recipients, 31 (8.5%) developed biliary strictures, and 27 met inclusion criteria (12 males, 15 females). A total of 87 ERCP sessions were performed, with an overall success rate of 70.4%. Six patients (22.2%) required percutaneous transhepatic biliary drainage, and two (7.4%) underwent surgical intervention. Serum ALT and ALP levels significantly decreased after ERCP (ALT: 123 to 46 U/L, p = 0.02; ALP: 767 to 568 U/L, p = 0.028; Wilcoxon signed-rank test), whereas total bilirubin changes were not significant. Complications occurred in 12.6% of procedures, mainly mild post-ERCP pancreatitis (6.9%), all managed conservatively.
CONCLUSIONS: ERCP is a safe and effective initial treatment for post-transplant biliary strictures in children. Complications are generally minor and manageable, supporting its role as a minimally invasive therapeutic option in pediatric liver transplant centers.