Biliary strictures in liver transplant recipients: treatment with metal stents.

Abstract

To determine initial and long-term results of metal stent placement in biliary strictures that failed to respond to balloon dilation. Sixty-one metal stents were placed in 36 liver transplant recipients (age range, 3 months to 71 years) with biliary strictures that failed to respond to balloon dilation. Patients were followed up for up to 5 years. Initial stent placement was successful in all patients. Primary patency was 44% at 3 years and was 0% at 5 years; secondary patency was maintained at 88% at those intervals. Patency associated with the Gianturco Z stent was superior to that with the Palmaz stent. Stents located at anastomotic sites had higher patency rates than those at nonanastomotic sites. Major stent-related complications occurred in eight patients and included two pediatric deaths. Metal stents can be useful in the short term but have limited patency, often require repeat intervention, and have substantial complications. Long-term success depends heavily on repeat interventions or stent removal.