Biliary Stents

It is not uncommon for liver transplant patients to develop biliary strictures. There are several ways to manage these strictures. They can undergo surgical repair or they can be managed with placement of a trans-hepatic biliary stent. We usually try to treat the strictures with stent placement first. If this fails then we go to surgical repair. The stents are placed at Christiana in their interventional radiology suite. Arrangement for transportation and scheduling is handled by the nurse practitioners. Several things need to be done prior to their going to Christiana.

• Patients need to be NPO except for meds. The time depends on the time the test is scheduled.
  
• Patient needs to have labs including a PT/PTT prior to going to Christiana.
  
• Patient needs to have IV antibiotics prior to placement of stent. Antibiotic choice depends on whether patient has had previous episode of cholangitis.
  

The patient is usually recovered at Christiana prior to coming back. When the patient returns they need to:

• Continue IV antibiotics for at least 24 hours after the placement of the stent.
  
• Stent should be flushed with normal saline 5 cc's Q 24 hours.
  
• Labs should be repeated the morning after placement.
  
• Parent's need to be instructed by nurse on stent care and dressing changes.