{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T03:44:19Z","timestamp":1768967059387,"version":"3.49.0"},"reference-count":7,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,22]],"date-time":"2025-03-22T00:00:00Z","timestamp":1742601600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Biliary strictures (BS) remain a challenge in pediatric liver transplant (LT). Achievement of the \u201cOptimal Biliary Outcome\u201d (OBO), stricture resolution without recurrence or surgery is the goal. We analyzed cost associated with different management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Society of Pediatric LT (SPLIT) data were matched with Pediatric Health Information System (PHIS) data by dates of birth and transplant, center and sex. SPLIT data were used to identify LT recipients (2011\u20132016) with BS. Procedure and admissions costs from PHIS were inflation\u2010adjusted to 2022. Sub\u2010analyses evaluated costs associated with achieving OBO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Optimal biliary outcome was achieved in 42% of 77 participants following a median of 4 procedures and 2 inpatient nights compared to a median of 7 procedures and 4 nights in those without OBO (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). BS management was lower in participants who achieved OBO versus who did not achieve OBO (<jats:italic>p<\/jats:italic>\u2009=\u20090.004). Significant center variation in cost was observed (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Biliary strictures diagnosed earlier post\u2010PLT were associated with lower costs per patient (<jats:italic>p<\/jats:italic>\u2009=\u20090.049), while those who underwent surgical biliary revision did not incur higher costs per patient (<jats:italic>p<\/jats:italic>\u2009=\u20090.17). In participants who did not achieve OBO and underwent \u2265\u20096 PTC procedures tended to incur much higher costs compared to those who underwent \u2264\u20095 PTC procedures, regardless of surgical biliary revision (<jats:italic>p<\/jats:italic>\u2009=\u20090.08).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Biliary stricture management costs were highest in patients requiring treatment for recurrence or surgical biliary revision and lowest earlier post\u2010transplant, suggesting that more aggressive management upfront may optimize costs. Future work will explore practice variation and cost\u2010effective strategies to achieve OBO.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.70009","type":"journal-article","created":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T11:16:15Z","timestamp":1742728575000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Procedure Costs Associated With Management of Biliary Strictures in Pediatric Liver Transplant Recipients in the Society of Pediatric Liver Transplantation (SPLIT) Registry"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8227-2004","authenticated-orcid":false,"given":"Pamela L.","family":"Valentino","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Pediatrics, Seattle Children's Hospital University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6935-0012","authenticated-orcid":false,"given":"James D.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Department of Surgery University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3575-8386","authenticated-orcid":false,"given":"Sarah A.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Children's Hospital Colorado and the University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4021-5615","authenticated-orcid":false,"given":"Amy G.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Children's Hospital Colorado and the University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8399-8870","authenticated-orcid":false,"given":"Anna M.","family":"Banc\u2010Husu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas S.","family":"Fishman","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6767-8874","authenticated-orcid":false,"given":"John C.","family":"Bucuvalas","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Pediatrics and Recanati\u2010Miller Transplant Institute Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0302-0982","authenticated-orcid":false,"given":"Regino P.","family":"Gonzalez\u2010Peralta","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology, Hepatology and Liver Transplantation, AdventHealth for Children AdventHealth Transplant Institute  Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2624-8632","authenticated-orcid":false,"given":"George","family":"Mazariegos","sequence":"additional","affiliation":[{"name":"Hillman Center for Pediatric Transplantation Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhargava","family":"Mullapudi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Brendan Tripp Elam Transplant Center Children's Mercy Hospital Kansas City  Kansas City Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9998-5692","authenticated-orcid":false,"given":"Vicky L.","family":"Ng","sequence":"additional","affiliation":[{"name":"Transplant and Regenerative Medicine Center, Hospital for Sick Children University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shikha S.","family":"Sundaram","sequence":"additional","affiliation":[{"name":"Children's Hospital Colorado and the University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6436-4343","authenticated-orcid":false,"given":"Nada A.","family":"Yazigi","sequence":"additional","affiliation":[{"name":"MedStar Georgetown Transplant Institute  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennie","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Patient Advocate  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0899-7234","authenticated-orcid":false,"given":"Kyle","family":"Soltys","sequence":"additional","affiliation":[{"name":"Hillman Center for Pediatric Transplantation Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the Society of Pediatric Liver Transplantation (SPLIT)","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.26379"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/LVT.0000000000000082"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-018-2011-8"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13379"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13168"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2013.06.006"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2017.3033"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T10:29:10Z","timestamp":1760092150000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,22]]},"references-count":7,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1111\/petr.70009"],"URL":"https:\/\/doi.org\/10.1111\/petr.70009","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,22]]},"assertion":[{"value":"2024-09-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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