The safety and efficacy of the percutaneous balloon-expandable biodegradable magnesium biliary stents in patients with liver transplant

This study aims to present our institutional experience with the use of percutaneous balloon-expandable biodegradable magnesium biliary stents (MBS) in the treatment of benign, refractory anastomotic strictures (AS), where initial percutaneous or endoscopic approaches fail or are ineffective, after liver transplantation (LT). In this retrospective single-center study, 13 patients with clinically refractory AS who underwent MBS placement between July 2021 and August 2024 were evaluated. Statistical analyses included Kaplan-Meier survival analysis for patency and Spearman's correlation for recurrence risk. Primary outcomes included stricture recurrence and time to reintervention during follow-up. The median age of patients was 35 years [interquartile range (IQR): 22-48], and 11 were male (85%). Living donor LT was performed in 12 (92%). The MBS were placed at a median of 8 months post-transplant (IQR: 5-44), with a technical success in all cases (100%). Before MBS placement, patients underwent a median of one endoscopic retrograde cholangiopancreatography (IQR: 0-3) and three percutaneous transhepatic biliary drainage procedures (IQR: 1-8). The median follow-up was 25 months (IQR: 15-33). The MBS patency rates were 93%, 85%, and 67% at 6, 12, and 24 months, respectively. Stricture recurrence occurred at a median of 30 months post-placement (95% confidence interval: 23.6-36.3). A moderate positive correlation was observed between the number of pre-stent interventions and recurrence risk (rho: 0.582, P = 0.023). Post-procedural complications (cholangitis) occurred in 1 patient. Balloon-expandable biodegradable MBS may provide a safe and effective treatment for refractory AS following LT. Early placement of MBS, particularly after fewer prior interventions, appears to be associated with improved patency and longer stricture-free survival. Early use of biodegradable magnesium stents after LT may reduce the need for multiple interventions and improve long-term biliary patency.