Bile leakage after living donor liver transplantation demonstrated with hepatobiliary scan using99Tc-PMT

Abstract

Although it is recognized that hepatobiliary scan is of value in assessing postoperative complications of biliary surgery or cadaveric whole liver transplantation, there have been few reports regarding its usefulness following living donor liver transplantation. We performed living donor liver transplantation in a patient with biliary cirrhosis due to hepatolithiasis, using a right lobe graft from her sister. On the 15th postoperative day, bile discharge appeared from the operative wound. The leakage point could not be identified by computed tomography and cholangiography from the biliary drainage catheter. Hepatobiliary scan with Tc-99m Sn-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) demonstrated biliary extravasation from the left side of the anastomosis of the hepatico-jejunostomy, indicating biliary leakage from the anastomosis. Conservative therapy was continued because the radioisotope flowed smoothly into the reconstructed jejunum and the biliary drainage catheter, and the leakage was stopped on the 63th postoperative day. Hepatobiliary scan is useful in determining the therapeutic plan as well as detection of bile leakage and identification of leakage points after living donor liver transplantation.

Early Postoperative Monitoring of the Liver Graft

“…In patients without a T-tube, ERC is the standard diagnostic method. Hepatobiliary scintigraphy (HIDA) can be useful in cases where there is a low suspicion of leakage [94].…”

Metal-Based Complexes as Pharmaceuticals for Molecular Imaging of the Liver

“…The 99m Tc complexes of pyridoxylidene amino acids have also been applied for hepatobiliary scintigraphy [135,154,155], and one of these tracers, 99m Tc-PMT, is still used in clinical routine in Japan [156,157,158,159]. Due to the fact of its specific hepatic uptake, it is also possible to identify bone metastasis of HCC [160].…”