Fully Covered Metal Stents Provide Respectable Efficacy for Posttransplant Strictures

Biliary leaks and strictures are among the most common adverse events after liver transplantation. Anastomotic strictures are generally managed using endoscopic balloon dilation and stenting with multiple plastic stents or single, fully covered, self-expanding metal stents (FCSEMS) over a number of months. 

This report provides 5-year follow-up data on a prospective, multicenter study from the industry-sponsored Benign Biliary Stenoses Working Group. Patients with anastomotic strictures after orthotopic liver transplantation were treated with a commercially available FCSEMS for 4 to 6 months, then followed for 5 years or until stricture recurrence, with documentation of stent-related serious adverse events, stricture recurrence, and need for stent replacement after initial therapy. 

Among 41 patients, 33 had their stents removed per protocol and 8 were noted to experience spontaneous complete migration from the biliary tree. After stent removal or spontaneous passage, the 5-year probability of remaining stent-free was 48.9% (95% confidence interval [CI], 33.2%-64.7%) on an intention-to-treat basis for all patients. Five-year stent-free intervals were more common among those groups with longer stent retention (60.9% for retention >4 months in 31 patients; 95% CI, 43.6%−78.2%) and those with complete stricture resolution (72.6% for 28 patients, with a median dwell time of 5.0 months; 95% CI, 55.3%−90%). Ten patients experienced cholangitis, and 1 or more severe adverse events occurred in 16 patients (39%).