Percutaneous transhepatic cholangiography and biliary drainage after liver transplantation: A five-year experience

Abstract

Evaluation of the biliary tract by percutaneous transhepatic cholangiography (PTC) is often required in liver transplant patients with an abnormal postoperative course. Indications for PTC include failure of liver enzyme levels to return to normal postoperatively, an elevation of serum bilirubin or liver enzyme levels, suspected bile leak, biliary obstructive symptoms, cholangitis, and sepsis.Over a 5-year period 625 liver transplants in 477 patients were performed at the University Health Center of Pittsburgh. Fifty-three patients (56 transplants) underwent 70 PTCs. Complications diagnosed by PTC included biliary strictures, bile leaks, bilomas, liver abscesses, stones, and problems associated with internal biliary stents.Thirty-two percutaneous transhepatic biliary drainage procedures were performed. Ten transplantation patients underwent balloon dilatation of postoperative biliary strictures. Interventional radiologic techniques were important in treating other complications and avoiding additional surgery in many of these patients. KeywordsCholangiography; percutaneous transhepatic -Bile ducts; percutaneous drainage -Liver; transplantation Liver transplantation has now become an acceptable therapy for advanced, irreversible liver disease in both children and adults [1,2]. In patients with an abnormal posttransplantation course, a biliary tract complication is a primary diagnostic consideration. If serious biliary complications are not recognized and corrected promptly, there is no chance for the immunosuppressed liver transplant patient to survive [3].In the early postoperative period, most liver transplant patients have a T-tube in the common bile duct that permits easy examination by T-tube cholangiography [4]. However, direct access to the biliary tree via a percutaneous tube is not always available, particularly in the late postoperative period. In many such patients, percutaneous transhepatic cholangiography (PTC) is the preferred, or only, means of evaluating the biliary tree. NIH Public Access Author ManuscriptGastrointest Radiol. Author manuscript; available in PMC 2010 November 1. Published in final edited form as:Gastrointest Radiol. 1987 ; 12(2): 137-143. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptA PTC procedure permits the diagnosis of a variety of posttransplant complications that may require early surgical intervention. In selected cases, percutaneous transhepatic biliary drainage (PTBD) and related interventions, such as balloon dilatation of strictures and transhepatic removal of internal stents, may be performed to avoid further complications and additional surgical procedures. In this paper, we report our experience with PTC, PTBD, and related techniques in 56 pediatric and adult liver transplants. Subjects and MethodsDuring the 5 years from January, 1981 to January, 1986 received 625 orthotopic liver transplants. One hundred and forty-eight retransplants, including both first and second retransplants (78 in adults, 70 in children), were performed. Th...

Endoscopic Management of Biliary Leaks After T-Tube Removal in Liver Transplant Recipients: Nasobiliary Drainage Versus Biliary Stenting

“…[5][6][7] Although the clinical picture prompts the diagnosis of biliary leakage in most patients, the diagnosis is also suggested in a minority of patients based on fluctuating cyclosporine levels, pneumoperitoneum, or increased leakage through the Ttube tract. 8 The management of biliary leakage after elective Ttube removal has evolved with increased experience from surgery, 4,9-11 watchful waiting and/or supportive care, 12,13 interventional radiology, [14][15][16] and endoscopy. 5,17,18 Results of percutaneous transhepatic cholangiograpy and endoscopic intervention were initially discouraging because of poor results compared with surgery 19 and concerns of damage to the donor liver.…”

Retained surgical stents as a cause of biliary obstruction in pediatric liver transplants

“…When a choledochocholedochostomy is performed, a surgical T tube is frequently left in place, but when a choledochojejunostomy or a hepaticojejunostomy is performed, an internal stent is frequently placed [1]. At our institution, these stents are small-caliber plastic feeding tubes designed to pass into the small bowel once the biliary sutures dissolve [2,3].…”

“…To aid in suturing of the ducts, surgeons frequently place small plastic stents. At our institution 5-and 3.5-French plastic pediatric feeding tubes (Covidien, Mansfield, MA) are used in every hepaticojejunostomy and choledochojejunostomy [1]. These have been used routinely at this institution for more than 20 years and are also used in many pediatric transplant centers, (Kyle Soltys MD, personal communication) and they generally pass spontaneously [2].…”

Dilated periportal lymphatics mimicking an anastomotic bile leak after liver transplantation

“…One vital aspect of postoperative care is the frequent use of cholangiography, both routinely and when biliary complications are suspected [2,3]. Most of these biliary complications occur in the first weeks after transplantation.…”