Biodegradable stents for biliary strictures after pediatric liver transplantation: a multicenter retrospective study

Objectives: Biodegradable biliary stents are used to treat benign biliary strictures in adults. However, there is limited data regarding their use in pediatric patients. This study aims to assess the efficacy and safety of biodegradable biliary stents following pediatric liver transplantation (pLT). Materials and methods: Consecutive pLT patients with benign biliary strictures were retrospectively evaluated in five tertiary centers between October 2014 and May 2024. All patients underwent percutaneous bilioplasty followed by the placement of self-expanding polydioxanone-based stents. Stricture features and treatment timing were assessed, as well as freedom from stricture recurrence and complications. Results: A total of 102 patients (52 males, 50 females; median age at treatment = 5 years, interquartile range (IQR) = 2–11 years) were included. At baseline, 58/102 (57%) had a stricture length ≥ 10 mm, and 53/102 (52%) had intrahepatic duct involvement. Stenting was performed a median of 55 days (IQR = 15–128 days) following biliary drainage. Technically successful stent placement was achieved in 101/102 (99%) cases, and low-grade complications occurred in 19/102 (19%). During a median follow-up of 793 days (IQR = 341–1529 days), 24/102 (24%) patients had stricture recurrence with an estimated median time to recurrence of 2915 days. Eight patients were lost to follow-up before recurrence. Logistic regression did not identify any factors that were independent predictors of stricture recurrence, while Cox regression showed that recoil/residual stenosis was independently associated with earlier recurrence (p = 0.005; HR = 5.334; 95% CI = 1.674–17). Conclusion: Biodegradable stents appear safe and effective for treating biliary strictures after pLT. Certain factors may contribute to failure and should inform patient selection and the optimal timing for stenting. Key Points: Question The management of biliary strictures after pediatric liver transplantation (pLT) poses several challenges due to the frailty of the population and refractoriness of the condition. Findings In this multicenter study self-expanding biodegradable biliary stents made of polydioxanone proved to be safe and effective for the treatment of biliary strictures after pLT. Clinical relevance Biodegradable biliary stents may improve the management of biliary strictures after pLT with a positive impact on outcomes and less invasiveness; some factors may help to predict the outcome and define the best timing for stenting.