Postoperative biliary adverse events following orthotopic liver transplantation: Assessment with magnetic resonance cholangiography

Abstract

Biliary adverse events following orthotopic liver transplantation (OLT) are relatively common and continue to be serious causes of morbidity, mortality, and transplant dysfunction or failure. The development of these adverse events is heavily influenced by the type of anastomosis during surgery. The low specificity of clinical and biologic findings makes the diagnosis challenging. Moreover, direct cholangiographic procedures such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography present an inadmissible rate of adverse events to be utilized in clinically low suspected patients. Magnetic resonance (MR) maging with MR cholangiopancreatography is crucial in assessing abnormalities in the biliary system after liver surgery, including liver transplant. MR cholangiopancreatography is a safe, rapid, non-invasive, and effective diagnostic procedure for the evaluation of biliary adverse events after liver transplantation, since it plays an increasingly important role in the diagnosis and management of these events. On the basis of a recent systematic review of the literature the summary estimates of sensitivity and specificity of MR cholangiopancreatography for diagnosis of biliary adverse events following OLT were 0.95 and 0.92, respectively. It can provide a non-invasive method of imaging surgical reconstruction of the biliary anastomoses as well as adverse events including anastomotic and non-anastomotic strictures, biliary lithiasis and sphincter of Oddi dysfunction in liver transplant recipients. Nevertheless, conventional T2-weighted MR cholangiography can be implemented with T1-weighted contrast-enhanced MR cholangiography using hepatobiliary contrast agents (in particular using Gd-EOB-DTPA) in order to improve the diagnostic accuracy in the adverse events' detection such as bile leakage and strictures, especially in selected patients with biliary-enteric anastomosis.

Prognostic impact of postoperative low platelet count after liver transplantation

“…21 Biliary complications are associated with infectious complications, readmission, and multiple radiological, endoscopic or surgical interventions. 22 It is presumed that Our results suggest that maintaining platelet counts ≥72 500/μL on POD 5 could potentially improve graft and overall survival. This hypothesis is supported by separate reports from Han et al and Kim et al 23,24 both showing that platelet transfusion after living donor LT was positively correlated with graft regeneration.…”

“…In our preliminary study, we found that low platelet count on POD 5 was strongly related with biliary anastomotic strictures, which developed as a late complication . Biliary complications are associated with infectious complications, readmission, and multiple radiological, endoscopic or surgical interventions . It is presumed that these late complications might impact on long‐term graft and overall survival.…”

Ultrasound of Biliary Cast Syndrome and Its Mimics

“…11 On 3D MRCP, biliary casts and calculi appear as hypointense filling defects within the biliary tree surrounded by a rim of hyperintense bile. Axial imaging may help differentiate biliary casts from pneumobilia by the latter's nondependent position.…”

“…12 Ischemic biliary strictures can be visualized as long, segmental areas of narrowing of the intrahepatic ducts that often begin at the biliary confluence and radiate peripherally. 11 Anastomotic strictures appear as circumferential, focal stenosis at the anastomosis, associated proximal dilatation of the biliary tract. Magnetic resonance imaging (MRI) also demonstrates circumferential wall thickening of the main ducts.…”

Role of endoscopy in the conservative management of biliary complications after deceased donor liver transplantation

“…After exclusion of both vascular and parenchymal conditions that could justify the manifestation, magnetic resonance cholangio-pancreatography (MRCP) or even a cholangiogram through a T-tube are considered the diagnostic standard for biliary tract complications [9] . Invasive approaches, such as endoscopic retrograde cholangiography (ERC) or percutaneous trans-hepatic cholangiography (PTC) should be considered treatment options rather than diagnostic tools.…”