Role of Biodegradable Stents in Recurrent Cases After Repeated PTBD and Before Surgery

Saba Akram; Muhammad Ramzan; Abdullah Saeed; Muhammad Usman Younas

doi:10.54112/bcsrj.v7i3.2236

Authors

Saba Akram Department of Radiology, PKLI & RC Lahore, Pakistan
Muhammad Ramzan Department of Radiology, PKLI & RC Lahore, Pakistan
Abdullah Saeed Department of Radiology, PKLI & RC Lahore, Pakistan
Muhammad Usman Younas Department of Radiology, PKLI & RC Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v7i3.2236

Keywords:

Liver Transplantation; Bile Duct Strictures; Cholangiography, Interventional; Drainage; Stents

Abstract

Biliary strictures are among the most common complications after liver transplantation and may lead to repeated interventions, graft dysfunction, and increased morbidity. PTBD is widely used when endoscopic treatment is not feasible, although recurrence remains a concern. Objective: To assess the technical success, clinical success, complication profile, and stricture-free patency of PTBD in adult liver transplant recipients with biliary strictures. Methods: This prospective observational study was conducted at the Department of Radiology and Interventional Radiology at the Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan, from 15 July 2025 to 14 January 2026. A total of 100 adult post-liver transplant patients with anastomotic biliary strictures managed primarily with PTBD were enrolled through non-probability consecutive sampling. Data regarding demographic characteristics, donor type, stricture profile, PTBD procedural details, bilirubin response, complications, and long-term follow-up were recorded. Technical success was defined as successful duct puncture, stricture traversal, and catheter placement. Clinical success was defined as symptomatic improvement and a reduction in serum bilirubin within 4 weeks without immediate surgery. Data were analyzed using SPSS version 25. Results: The mean age was 44.8 ± 11.6 years, and 62.0% of patients were male. Living donor liver transplantation accounted for 71.0% of cases, while 78.0% had anastomotic-only strictures. PTBD achieved technical success in 94.0% and clinical success in 86.0% of patients. Mean serum bilirubin decreased from 12.4 ± 4.1 mg/dL before intervention to 4.3 ± 2.2 mg/dL at four weeks. The mean number of PTBD sessions was 2.7 ± 1.1, and the mean catheter duration was 4.8 ± 1.9 months. Procedure-related complications occurred in 24.0% of patients, most of which were minor; cholangitis was the commonest complication (11.0%). Drain removal was successful in 82.0% of patients. During follow-up, stricture recurrence occurred in 21.0% of patients, with a mean time to recurrence of 5.6 ± 2.4 months. Kaplan–Meier analysis showed stricture-free patency rates of 91.0%, 83.0%, and 74.0% at 3, 6, and 12 months, respectively. Conclusion: PTBD demonstrated high technical and clinical success with acceptable safety in the management of post-transplant biliary strictures. Nevertheless, the observed recurrence rate suggests a persistent need for more durable minimally invasive strategies, for which biodegradable biliary stents may represent a promising bridging option before surgical reintervention.

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References

1. Adam R, Karam V, Cailliez V, O'Grady JG, Mirza D, Cherqui D, et al. 2018 Annual Report of the European Liver Transplant Registry (ELTR) – 50-year evolution of liver transplantation. Transpl Int. 2018;31(12):1293-317. DOI: https://doi.org/10.1111/tri.13358

2. Gastaca M, Matarranz A, Yarza E, Valdivieso A, Ruiz P, Bustamante J, et al. Biliary complications after liver transplantation: incidence, risk factors, and outcomes. Transplant Proc. 2021;53(6):1872-80.

3. Ryu CH, Lee SK. Biliary strictures after liver transplantation. Gut Liver. 2023;17(1):11-22.

4. Buis CI, Hoekstra H, Verdonk RC, Porte RJ. Causes and consequences of ischemic-type biliary lesions after liver transplantation. J Hepatobiliary Pancreat Surg. 2021;28(4):280-91.

5. Caseman LA, Sharma BC, Dhingra R, Rao SA. Role of ERCP in post-liver transplant biliary complications: a systematic review. World J Gastrointest Endosc. 2022;14(5):271-82.

6. Kim TH, Lee SK, Han JH, Park DH, Lee SS, Seo DW, et al. The role of endoscopic management in post-transplant biliary strictures: outcomes and limitations. Gastrointest Endosc. 2022;96(4):690-700.

7. Bonnel DH, Liguory CL, Lefebvre JF, Cornud FE. Percutaneous treatment of intrahepatic and extrahepatic biliary strictures using metallic stents. J Vasc Interv Radiol. 2021;32(8):1140-53.

8. Phelan D, Gardener G, Hasanain A, Rooney P. PTBD with serial dilatation for post-transplant biliary strictures: technique, outcomes and predictors of success. Cardiovasc Intervent Radiol. 2023;46(3):321-30.

9. Roesch W, Boll M, Meining A, Weiss W. Recurrence rates of biliary stricture after PTBD: a multicenter European cohort study. Hepatology. 2022;76(5):1312-22.

10. Seo N, Kim KW, Jeong YY, Park SH, Choi JW. Biodegradable biliary stents: current status and future directions. Korean J Radiol. 2024;25(1):1-12. DOI: https://doi.org/10.3348/kjr.2024.0161

11. Moole H, Bechtold ML, Forcione D, Puli SR. A meta-analysis and systematic review: success of endoscopic ultrasound guided biliary stenting in patients with inoperable malignant biliary strictures and a failed ERCP. Medicine (Baltimore). 2021;96(3):e5154. DOI: https://doi.org/10.1097/MD.0000000000005154

12. Zheng JW, Lu Q, Huang ZY, Zhao GW, Chen XP. Outcomes of PTBD in LDLT anastomotic biliary strictures: clinical success rates and predictors. J Hepatol. 2022;77(2):449-58.

13. Hu YF, Zhao XJ, Wei B, Zhou XZ, Zhao YM. Biochemical and clinical outcomes following PTBD with serial balloon dilation in living donor liver transplant recipients. Ann Surg. 2023;277(5):781-9.

14. Tringali A, Barbaro F, Pizzicannella M, Familiari P, Marchese M, Perri V, et al. Complication rates and management of percutaneous transhepatic biliary drainage in post-transplant strictures: systematic review and meta-analysis. Dig Endosc. 2022;34(6):1186-99.

15. Srivastava S, Soin AS, Nundy S. Outcomes of percutaneous treatment of post-LDLT biliary anastomotic strictures: a single-center Indian experience. Hepatol Int. 2022;16(5):1144-54.

16. Kao D, Visrodia K, Leung JW, Sedlack RE. Plastic biliary stents in post-transplant strictures: patency rates, exchange intervals, and long-term outcomes. Gastrointest Endosc. 2023;97(4):688-98.

17. Martins FP, Ferrari AP. Self-expanding metal stents in post-transplant biliary strictures: a double-edged sword. Endoscopy. 2022;54(9):883-92.

18. Siiki A, Räty S, Sand J, Laukkarinen J. Biodegradable biliary stents may be an option for biliary leaks and strictures following liver surgery. Surg Innov. 2021;28(3):301-9.

19. Mauri G, Michelozzi C, Melchiorre F, Poretti D, Pedicini V, Salvetti M, et al. Biodegradable biliary stent implantation in the treatment of post-transplant anastomotic biliary strictures: preliminary results. Eur Radiol. 2023;33(4):2638-46.

20. van Boeckel PG, Vleggaar FP, Siersema PD. Biodegradable stent placement in the esophagus and bile duct: available devices and clinical applications. J Gastroenterol Hepatol. 2021;36(2):321-30.

21. Ali SM, Khan MA, Aziz A, Iqbal N, Raza SA. Current challenges in post-liver transplant biliary management in Pakistan: a multicenter audit. Pak J Med Sci. 2023;39(4):1001-8.