Lim C, Ng J, Sarraf B, Vaughan R, Efthymiou M, Zorron Cheng Tao Pu L, Chandran S. Safety and efficacy of Kaffes intraductal self-expanding metal stents in the management of post-liver transplant anastomotic strictures. World J Transplant 2024; 14(2): 91081 [PMID: 38947975 DOI: 10.5500/wjt.v14.i2.91081]
Corresponding Author of This Article
Leonardo Zorron Cheng Tao Pu, MD, MSc, PhD, Doctor, Staff Physician, Department of Gastroenterology and Hepatology, Austin Health, 145 Studley Road 8th floor, Harold Stokes Building, Advanced Endoscopy Unit, Melbourne Heidelberg, VIC 3084, Australia. leozorron@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Jun 18, 2024; 14(2): 91081 Published online Jun 18, 2024. doi: 10.5500/wjt.v14.i2.91081
Safety and efficacy of Kaffes intraductal self-expanding metal stents in the management of post-liver transplant anastomotic strictures
Chee Lim, Jonathan Ng, Babak Sarraf, Rhys Vaughan, Marios Efthymiou, Leonardo Zorron Cheng Tao Pu, Sujievvan Chandran
Chee Lim, Jonathan Ng, Babak Sarraf, Rhys Vaughan, Marios Efthymiou, Leonardo Zorron Cheng Tao Pu, Sujievvan Chandran, Department of Gastroenterology and Hepatology, Austin Health, Melbourne Heidelberg, VIC 3084, Australia
Rhys Vaughan, Marios Efthymiou, Leonardo Zorron Cheng Tao Pu, Sujievvan Chandran, Melbourne Medical School, The University of Melbourne, Melbourne Parkville, VIC 3052, Australia
Author contributions: Chandran S, Efthymiou M and Vaughan R formulated the research question; Chandran S designed the study; Lim C, Ng J and Sarraf B conducted the research; Lim C and Zorron Cheng Tao Pu L analyzed and interpreted the data; Lim C and Zorron Cheng Tao Pu L wrote the manuscript. All authors have read and approve the final manuscript.
Institutional review board statement: The project has been reviewed by Austin Health Office for Research against the principles of the National Statement on Ethical Conduct in Research (2007, updated 2018) and approved. (Approval Number: Audit/22/Austin/43).
Informed consent statement: This is an informed consent exemption statement. This application is a clinical audit project involving the collection, use and disclosure of the data in a de-identified format to be conducted at Austin Health. Such data is to be accessed by an Austin Health employee only.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at leonardo.zorronchengtaopu@austin.org.au. Presented data was de-identified and anonymised, and risk of identification is low.
STROBE statement: The authors have read the STROBE statement-checklist of items, and the manuscript was prepared and revised according to the STROBE statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Leonardo Zorron Cheng Tao Pu, MD, MSc, PhD, Doctor, Staff Physician, Department of Gastroenterology and Hepatology, Austin Health, 145 Studley Road 8th floor, Harold Stokes Building, Advanced Endoscopy Unit, Melbourne Heidelberg, VIC 3084, Australia. leozorron@gmail.com
Received: December 21, 2023 Revised: March 8, 2024 Accepted: March 25, 2024 Published online: June 18, 2024 Processing time: 175 Days and 22.5 Hours
Abstract
BACKGROUND
Endoscopic management is the first-line therapy for post-liver-transplant anastomotic strictures. Although the optimal duration of treatment with plastic stents has been reported to be 8-12 months, data on safety and duration for metal stents in this setting is scarce. Due to limited access to endoscopic retrograde cholangiopancreatography (ERCP) during the coronavirus disease 2019 pandemic in our centre, there was a change in practice towards increased usage and length-of-stay of the Kaffes biliary intraductal self-expanding stent in patients with suitable anatomy. This was mainly due to the theoretical benefit of Kaffes stents allowing for longer indwelling periods compared to the traditional plastic stents.
AIM
To compare the safety and efficacy profile of different stenting durations using Kaffes stents.
METHODS
Adult liver transplant recipients aged 18 years and above who underwent ERCP were retrospectively identified during a 10-year period through a database query. Unplanned admissions post-Kaffes stent insertion were identified manually through electronic and scanned medical records. The main outcome was the incidence of complications when stents were left indwelling for 3 months vs 6 months. Stent efficacy was calculated via rates of stricture recurrence between patients that had stenting courses for ≤ 120 d or > 120 d.
RESULTS
During the study period, a total of 66 ERCPs with Kaffes insertion were performed in 54 patients throughout their stenting course. In 33 ERCPs, the stent was removed or exchanged on a 3-month interval. No pancreatitis, perforations or deaths occurred. Minor post-ERCP complications were similar between the 3-month (abdominal pain and intraductal migration) and 6-month (abdominal pain, septic shower and embedded stent) groups - 6.1% vs 9.1% respectively, P = 0.40. All strictures resolved at the end of the stenting course, but the stenting course was variable from 3 to 22 months. The recurrence rate for stenting courses lasting for up to 120 d was 71.4% and 21.4% for stenting courses of 121 d or over (P = 0.03). There were 28 patients that were treated with a single ERCP with Kaffes, 21 with removal after 120 d and 7 within 120 d. There was a significant improvement in stricture recurrence when the Kaffes was removed after 120 d when a single ERCP was used for the entire stenting course (71.0% vs 10.0%, P = 0.01).
CONCLUSION
Utilising a single Kaffes intraductal fully-covered metal stent for at least 4 months is safe and efficacious for the management of post-transplant anastomotic strictures.
Core Tip: Biliary strictures are the most common complication post orthotopic liver transplantation. This retrospective study evaluates the safety and efficacy of managing such strictures using intraductal fully-covered metal stent (Kaffes) for different durations. The results show that a single Kaffes stent indwelling for at least 4 months is safe and effective for treating post liver transplant anastomotic strictures.
