Introduction: Liver transplantation is the treatment of choice in patients with acute or chronic liver disease. Postoperative biliary complications are the most common and can limit the survival of both the graft and the patient. Biliary stenosis represents 80% of cases, depending on the time of appearance, they are classified as early; <6 months or late >6 months post-transplant.
Methods: Prospective, non-randomized study, in patients undergoing liver transplantation from a living donor during the period from 2023 to 2024 with the use of a biodegradable stent, the biochemical variables of liver function, as well as radio imaging studies will be recorded to evaluate the presence or no biliary complications during the study. The characteristics of the stend were standardized based on the weight and measurements of the patient and native bile duct.
Results: 8 stent placements were performed in 8 transplants, 2 patients died during the study unrelated to the stent placement and were therefore removed from the study, all of them were female, the diagnosis prior to transplantation were biliary atresia (BA) 2, hepatoblastoma 2, and acute liver failure (ALF) 2, with a median age of 22.5 months SD +13.2 months and a median of weight 10.7 kg SD +3.8 kg.(image 1). In 4 patients, left bilio-hepatic anastomosis was performed and in two patients, left hepatic anastomosis was performed toward roux. Follow-up was carried out for an average of 6 months with a minimum of 2 months and a maximum of 14 months. The degradation was demonstrable with a median of 4.5 months with SC 1.8 after placement. At the time of the study, all patients show adequate tolerance with no evidence of post-transplant biliary complications requiring biliary exploration or reconstruction. (image 2).
Conclusion: The placement of a biodegradable stent during liver transplant surgery is an alternative that so far has provided good post-surgical results in terms of the biliary complications that are reported in comparison with the use of other materials to fistulize the bile duct. The maximum degradation of 6 months during the period of this study makes it possible to have a bile duct without signs of obstruction in the first post-transplant period in which strictures occur. In our experience, open technique placement during transplantation prevents post-transplant procedures and complications. The measurement of the appropriate stend is important in patients under 20 kg, as demonstrated in our patients. The anatomical characteristics of the stend prevent obstruction or stenosis at the level of the anastomosis, corroborated by imaging studies, laboratory results and clinical evolution throughout the follow-up of our study. We present the first world report on the use of a biodegradable device in the bile duct in pediatric patients with an open approach in living donor liver transplantation.