Magnetic resonance cholangiopancreatography for the accurate diagnosis of biliary complications after liver transplantation: comparison with endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography – long‐term follow‐up

Abstract

Biliary complications after liver transplantation remain a serious cause of morbidity and mortality. Direct invasive cholangiographic techniques, endoscopic retrograde cholangiography (ERCP) or percutaneous transhepatic cholangiography (PTC), have procedure-related complications. Magnetic resonance cholangiopancreatography (MRCP) is non-invasive, safe, and accurate. The aim of this study was to evaluate MRCP in detecting biliary complications following liver transplantation and comparing findings with ERCP and PTC. Twenty-seven consecutive liver transplant recipients who presented with clinical and biochemical, ultrasonographic, or histological evidence of biliary complications were evaluated with MRCP. Patients were followed up for a median period of 36 months. The presence of a biliary complication was confirmed in 18 patients (66.6%): anastomotic biliary stricture in 12 (66.6%); diffuse intrahepatic biliary stricture in 5 (27.7%): ischemic (n = 3), recurrence of primary sclerosing cholangitis (n = 2), and choledocholithiasis in one. In nine patients (33.3%), MRCP was normal. Six patients underwent ERCP, and eight PTC. There was a statistically significant correlation between the MRCP and both ERCP and PTC (p = 0.01) findings. The sensitivity and specificity of the MRCP were 94.4% and 88.9%, respectively, and the positive and negative predictive values, 94.4% and 89.9%, respectively. MRCP is an accurate imaging tool for the assessment of biliary complications after liver transplantation. We recommend that MRCP be the diagnostic imaging modality of choice in this setting, reserving direct cholangiography for therapeutic procedures.

Magnetic resonance cholangiography in the assessment and management of biliary complications after OLT

“…In the case of positive MRC, the post-test probability of BC reaches 80% and 94%, respectively, whereas in the case of negative MRC, the post-test probability reduces to 1% and 4%, respectively. These estimates emphasize the results of previous direct comparison between MRC, ERC and PTC [54] , suggesting that the strength of MRC is represented by the large negative predictive value (94.4%), which is of help in excluding BC and avoiding unnecessary invasive procedures in patients with clinical low-to-moderate risk of BC [54] . Unfortunately, several methodological flaws affect the studies included in the above systematic reviews, including small sample size, uncertainty in clinical criteria defining the suspicion for BC, verification bias given the heterogeneity in the standard of reference tools and absence of a standardized MRC technique [1,55] .…”

“…For instance, some authors [47] have hypothesized that reduced biliary dilatation following post-OLT strictures might limit the accuracy of MRC. Detractors of MRC also argue that, although MRC correlates well with direct cholangiography procedures (P = 0.01) [54] , the examination delays the diagnosis when interventional ERC or PTC are finally needed. This is why the use of MRC still depends on local preferences based on availability, expertise and costs.…”

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

“…However, a prospective study of MRCP and ERC revealed comparable sensitivities for detection of biliary obstruction (13). Other studies confirmed a ≥90% sensitivity and specificity and positive and negative predictive values of 90% for MRCP (14,15). A normal MRCP therefore might avoid further invasive measures.…”

Endoscopic management of biliary strictures after living donor liver transplantation

“…Nevertheless, US with Doppler should be the initial modality for the evaluation of major vascular complications (e.g., hepatic artery thrombosis), which require urgent management. Magnetic resonance cholangiopancreatography (MRCP) has replaced ERCP as a noninvasive diagnostic modality for suspected post-LDLT biliary strictures, because its sensitivity and accuracy in the evaluation of biliary complications following transplantation are comparable to those of ERCP [45,46]. Unnecessary ERCP can be avoided in LDLT recipients when there is no evidence of biliary strictures on MRCP [47].…”