{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:39:56Z","timestamp":1791819596529,"version":"4.3.4"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2022,1,30]],"date-time":"2022-01-30T00:00:00Z","timestamp":1643500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,1,30]],"date-time":"2022-01-30T00:00:00Z","timestamp":1643500800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p>Biliary strictures affect 4%\u201012% of pediatric liver transplantations. Biliary strictures can contribute to graft loss if left untreated; however, there remains no consensus on the best course of treatment. Study objectives included analyses of outcomes associated with biliary stricture management strategies via percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP), or surgery. We identified pediatric liver transplantation recipients (2011\u20102016) with biliary strictures from the Society of Pediatric Liver Transplantation (SPLIT) registry and retrieved imaging, procedural, and operative reports from individual centers. Subanalyses were performed to specifically evaluate PTC and ERCP for \u201coptimal biliary outcome\u201d (OBO), defined as graft survival with stricture resolution and without recurrence or surgery. A total of 113 children with a median follow\u2010up of 3.9\u00a0years had strictures diagnosed 100\u00a0days (interquartile range, 30\u2010290) after liver transplantation; 81% were isolated anastomotic strictures. Stricture resolution was achieved in 92% within 101\u00a0days, more frequently with isolated anastomotic strictures (96%). 20% of strictures recurred, more commonly in association with hepatic artery thrombosis (32%). Patient and graft survival at 1 and 3 years were 99% and 98% and 94% and 92%, respectively. In a subgroup analysis of 79 patients with extrahepatic strictures managed by PTC\/ERCP, 59% achieved OBO following a median of 4 PTC, and 75% following a median of 3 ERCP (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). Among patients with OBO, those with ERCP had longer time intervals between successive procedures (41, 47, 54, 62, 71\u00a0days) than for PTC (27, 31, 36, 41, 48\u00a0days; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). Allograft salvage was successful across all interventions. Stricture resolution was achieved in 92%, with 20% risk of recurrence. Resolution without recurrence was highest in patients with isolated anastomotic strictures and without hepatic artery thrombosis.<\/jats:p>","DOI":"10.1002\/lt.26379","type":"journal-article","created":{"date-parts":[[2021,11,27]],"date-time":"2021-11-27T07:51:17Z","timestamp":1637999477000},"page":"819-833","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":24,"title":["North American Biliary Stricture Management Strategies in Children After Liver Transplantation: A Multicenter Analysis From the Society of Pediatric Liver Transplantation (SPLIT) Registry"],"prefix":"10.1097","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8227-2004","authenticated-orcid":false,"given":"Pamela L.","family":"Valentino","sequence":"first","affiliation":[{"name":"Section of Gastroenterology and Hepatology,Department of Pediatrics,Yale University School of Medicine,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianhao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Statistics and Data Science,Yale University,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Shabanova","sequence":"additional","affiliation":[{"name":"Department of Pediatrics,Yale University School of Medicine,New Haven,CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky Lee","family":"Ng","sequence":"additional","affiliation":[{"name":"Transplant and Regenerative Medicine Center,Hospital for Sick Kids,University of Toronto,Toronto,ON,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Bucuvalas","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai,New York,NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4021-5615","authenticated-orcid":false,"given":"Amy G.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Colorado and the University of Colorado School of Medicine,Aurora,CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regino P.","family":"Gonzalez\u2010Peralta","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Liver Transplantation,AdventHealth for Children,AdventHealth Transplant Institute,Orlando,FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitika Arora","family":"Gupta","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine,Atlanta,GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamir A.","family":"Miloh","sequence":"additional","affiliation":[{"name":"Division of Hepatology,Holtz Children\u2019s Hospital,University of Miami,Miami,FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2950-2552","authenticated-orcid":false,"given":"Saeed","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics,Feinberg School of Medicine,Northwestern University,Chicago,IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Pace","sequence":"additional","affiliation":[{"name":"Department of Radiology,The Royal Marsden NHS Foundation Trust,London,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shikha S.","family":"Sundaram","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Colorado and the University of Colorado School of Medicine,Aurora,CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada A.","family":"Yazigi","sequence":"additional","affiliation":[{"name":"MedStar Georgetown Transplant Institute,Washington,DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Soltys","sequence":"additional","affiliation":[{"name":"Hillman Center for Pediatric Transplantation,Children\u2019s Hospital of Pittsburgh,Pittsburgh,PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Society of Pediatric Liver Transplantation (SPLIT)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,1,30]]},"reference":[{"key":"lt26379-bib-0001-20250824","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/SLA.0b013e3180caa415","article-title":"Impact of graft type on outcome in pediatric liver transplantation: a report from Studies of Pediatric Liver Transplantation (SPLIT)","volume":"246","year":"2007","journal-title":"Ann Surg"},{"key":"lt26379-bib-0002-20250824","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.1097\/TP.0000000000001298","article-title":"Analysis of factors associated with biliary complications in children after liver transplantation","volume":"100","year":"2016","journal-title":"Transplantation"},{"key":"lt26379-bib-0003-20250824","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1002\/lt.24180","article-title":"Biliary complications in pediatric liver transplantation: incidence and management over a decade","volume":"21","year":"2015","journal-title":"Liver Transpl"},{"key":"lt26379-bib-0004-20250824","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1111\/petr.12729","article-title":"Outcomes after discontinuation of routine use of transanastomotic biliary stents in pediatric liver transplantation at a single site","volume":"20","year":"2016","journal-title":"Pediatr Transplant"},{"key":"lt26379-bib-0005-20250824","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1002\/lt.23910","article-title":"Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation","volume":"20","year":"2014","journal-title":"Liver Transpl"},{"key":"lt26379-bib-0006-20250824","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1111\/petr.12363","article-title":"Risk factors for early and late biliary complications in pediatric liver transplantation","volume":"18","year":"2014","journal-title":"Pediatr Transplant"},{"key":"lt26379-bib-0007-20250824","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1002\/lt.25845","article-title":"Bilioenteric reconstruction techniques in pediatric living donor liver transplantation","volume":"27","year":"2021","journal-title":"Liver Transpl"},{"issue":"suppl 2","key":"lt26379-bib-0008-20250824","first-page":"208","article-title":"OPTN\/SRTR 2019 annual data report: liver","volume":"21","year":"2021","journal-title":"Am J Transplant"},{"key":"lt26379-bib-0009-20250824","article-title":"Society of pediatric liver transplantation: current registry status 2011\u20102018","volume":"24","year":"2020","journal-title":"Pediatr Transplant"},{"key":"lt26379-bib-0010-20250824","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.trre.2017.03.002","article-title":"Management of biliary anastomotic strictures after liver transplantation","volume":"31","year":"2017","journal-title":"Transplant Rev"},{"key":"lt26379-bib-0011-20250824","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.jpeds.2020.06.053","article-title":"Decreased incidence of hepatic artery thrombosis in pediatric liver transplantation using technical variant grafts: report of the Society of Pediatric Liver Transplantation Experience","volume":"226","year":"2020","journal-title":"J Pediatr"},{"key":"lt26379-bib-0012-20250824","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1007\/s00423-019-01804-y","article-title":"Endoscopic treatment of biliary complications after duct\u2010to\u2010duct biliary anastomosis in pediatric liver transplantation","volume":"404","year":"2019","journal-title":"Langenbecks Arch Surg"},{"key":"lt26379-bib-0013-20250824","article-title":"Long\u2010term outcome of percutaneous transhepatic biliary drainage for biliary strictures following pediatric liver transplantation","volume":"33","year":"2019","journal-title":"Clin Transplant"},{"key":"lt26379-bib-0014-20250824","article-title":"Evaluation of a three\u2010session biliary dilation protocol following transplant\u2010related biliary stricture in pediatric patients","volume":"23","year":"2019","journal-title":"Pediatr Transplant"},{"key":"lt26379-bib-0015-20250824","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.gie.2017.07.025","article-title":"Liver transplant\u2010related anastomotic biliary strictures: a novel, rapid, safe, radiation\u2010sparing, and cost\u2010effective management approach","volume":"87","year":"2018","journal-title":"Gastrointest Endosc"},{"key":"lt26379-bib-0016-20250824","article-title":"Percutaneous interventional management of biliary complications after pediatric liver transplantation: a 16\u2010year single\u2010institution experience","volume":"21","year":"2017","journal-title":"Pediatr Transplant"},{"key":"lt26379-bib-0017-20250824","article-title":"Association of anesthesia and surgery during childhood with long\u2010term academic performance","volume":"171","year":"2017","journal-title":"JAMA Pediatr"},{"key":"lt26379-bib-0018-20250824","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1001\/jamapediatrics.2018.3662","article-title":"Influence of surgical procedures and general anesthesia on child development before primary school entry among matched sibling 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