Diagnostic Value of Ultrasound in Detection of Biliary Tract Complications After Liver Transplantation

Abstract

BackgroundBiliary complications are significant source of morbidity after liver transplantation (LT). Cholangiography is the gold standard for diagnosis and specification of biliary complications.ObjectivesDetailed analyses of ultrasound (US) as a safe imaging method in this regard are still lacking. Therefore we analyzed systematically the diagnostic value of US in these patients.Patients and MethodsRetrospectively, 128 liver graft recipients and their clinical data were analyzed. All patients had a standardized US examination. The findings of US were compared to cholangiographic results in 42 patients. Following statistical analyses were performed: descriptive statistics, sensitivity, specificity, positive and negative predictive values (PPV, NPV).Results42 patients had 54 different biliary complications (Anastomotic stenosis (AS) n = 33, ischemic type biliary lesions (ITBL) n = 18 and leakage n = 3). US detected n = 22/42 (52%) patients with biliary complications. The sensitivity, specificity, PPV and NPV of US were: 61%, 100%, 100%, 79% (95CI, 36-86%) for ITBL and 24%, 100, 100%, 31% (95CI, 9-46 %) for AS, respectively.ConclusionsUS examination had no false positive rate. Therefore, it may be helpful as a first screening modality. But for the direct diagnosis of the biliary complication US is not sensitive enough.

Posttransplant biopsy risk for stable long-term pediatric liver transplant recipients: 451 percutaneous biopsies from two multicenter immunosuppression withdrawal trials

“…Second, an episode of biopsy‐related cholangitis should trigger definitive evaluation for occult biliary stricture, either with endoscopic retrograde cholangiography or percutaneous transhepatic cholangiogram and biliary drainage. This recommendation is supported both by our data and by previous studies that describe the low sensitivity and specificity of liver tests, ultrasound examination, magnetic cholangiopancreatography (MRCP), and even liver biopsy to diagnose biliary stricture . These studies reveal a much lower sensitivity and specificity of both ultrasound and MRCP in detecting biliary strictures in patients with bilioenteric anastomoses instead of duct to duct, which is very commonly the case in children …”

Diagnosis and management of biliary complications in pediatric living donor liver transplant recipients

“…There are few reported studies on the clinical presentation of pediatric patients with BSs. Potthoff et al studied the value of US in the diagnosis of BSs in adult liver transplant recipients: the sensitivity of US for the detection of BSs was 24% with a negative predictive value of 31%. Other studies have reported different sensitivities of US for the detection of BSs ranging from 38% to 68%, but their samples have been mixed (adult and pediatric patients, living and deceased donors, and different types of biliary reconstruction).…”

Early Postoperative Monitoring of the Liver Graft

“…The abdominal US may not be sensitive enough (sensitivity 38-66%) to detect biliary obstruction [88]. Therefore, an additional evaluation with more sensitive techniques is recommended in patients with clinical suspicion.…”

“…They can be due to gallstones, sludges, blood clots, cylinders, and/or migrated stents [88]. Gallstones, cylinders, and sludge are relatively common after TL, with an incidence between 2.5 and 12%.…”