The role of sonography and transhepatic cholangiography in the diagnosis of biliary complications after liver transplantation

Zemel, Gerald; Zajko, Albert B.; Skolnick, M. Leon; Bron, Klaus M.; Campbell, William L.

doi:10.2214/ajr.151.5.943

Cited by 99 publications

(37 citation statements)

References 7 publications

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“…Otherwise, the diagnostic workup is mostly started with noninvasive imaging studies, bearing in mind that these sometimes fail to detect relevant stenoses after LT. Especially ultrasound is less sensitive after LT, since severe dilatation of the intrahepatic bile ducts is absent in >60% of patients with anastomotic stenosis (AS) (8). Even 1 week before ERC diagnosis of AS, 96% of patients revealed a normal ultrasound (9).…”

Section: Diagnosis Of Biliary Complicationsmentioning

confidence: 99%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

247

232

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Section: Diagnosis Of Biliary Complicationsmentioning

confidence: 99%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

247

232

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“…An absence of dilated ducts does not rule out biliary pathology and strictures frequently escape detection by ultrasonography. 28,29 Therefore, a cholestatic picture with a negative ultrasound result requires either a liver biopsy or cholangiogram. The choice depends on the clinical suspicion.…”

Section: Management Of Late Biliary Complicationsmentioning

confidence: 99%

Management of biliary problems after liver transplantation

Möser

Wall

2001

Liver Transplantation

110

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“…In contrast to patients without transplantation, US is reported to have a low sensitivity (close to 50%) for the diagnosis of posttransplant biliary congestion and strictures [13][14][15] . In contrast, Hussaini et al [16] , reported a high negative predictive value of 95% for transabdominal US in the diagnosis of biliary tract complications, when statistically adjusted for the low prevalence rate of biliary complications in their post liver transplant patients.…”

Section: Discussionmentioning

confidence: 95%

“…This may be due to the fact, that the post transplant bile ducts are often filled with epithelial cast, which could mask the true biliary diameter. Other authors presume that acute occlusion may not result in a prompt dilatation of the prestenotic bile ducts [13][14][15] . It is reported, that helical CT, which is often used to examine suspected vascular disease, can also demonstrate associated biliary complications [17] , although exact data are not available.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Biliary Strictures After Liver Transplantation: Which is the Best Tool?

&NA;

2005

Ultrasound Quarterly

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AIM:To evaluate the diagnostic value of different indirect methods like biochemical parameters, ultrasound (US) analysis, CT-scan and MRI/MRCP in comparison with endoscopic retrograde cholangiography (ERC), for diagnosis of biliary complications after liver transplantation. METHODS:In 75 patients after liver transplantation, who received ERC due to suspected biliary complications, the result of the cholangiography was compared to the results of indirect imaging methods performed prior to ERC. The cholangiography showed no biliary stenosis (NoST) in 25 patients, AST in 27 and ITBL in 23 patients. RESULTS:Biliary congestion as a result of AST was detected with a sensitivity of 68.4% in US analysis (specificity 91%), of 71% in MRI (specificity 25%) and of 40% in CT (specificity 57.1%). In ITBL, biliary congestion was detected with a sensitivity of 58.8% in the US, 88.9% in MRI and of 83.3% in CT. However, as anastomotic or ischemic stenoses were the underlying cause of biliary congestion, the sensitivity of detection was very low. In MRI detected the dominant stenosis at a correct localization in 22% and CT in 10%, while US failed completely. The biochemical parameters, showed no significant difference in bilirubin (median 5.7; 4,1; 2.5 mg/dL), alkaline phosphatase (median 360; 339; 527 U/L) or gamma glutamyl transferase (median 277; 220; 239 U/L) levels between NoST, AST and ITBL. CONCLUSION:Our data confirm that indirect imaging methods to date cannot replace direct cholangiography for diagnosis of post transplant biliary stenoses. However MRI may have the potential to complement or precede imaging by cholangiography. Optimized MRCP-processing might further improve the diagnostic impact of this method.

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The role of sonography and transhepatic cholangiography in the diagnosis of biliary complications after liver transplantation

Cited by 99 publications

References 7 publications

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Management of biliary problems after liver transplantation

Diagnosis of Biliary Strictures After Liver Transplantation: Which is the Best Tool?

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