Tc-99m-BrIDA hepatobiliary (HIDA) scan has a low sensitivity for detecting biliary complications after orthotopic liver transplantation in patients with hyperbilirubinemia

Hopkins, L. Olivia; Feyssa, Eyob; Parsikia, Afshin; Khanmoradi, Kamran; Zaki, Radi; Campos, Stalin; Araya, Víctor; Tran, Huyen D.; Ortíz, Jorge

doi:10.1007/s12149-011-0523-x

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…The results for detection of obstruction in the liver-resected group were not as good as in other studies [ 12 ]. Most comparable, retrospective studies showed good results for the detection of bile leak [ 3 , 12 , 16 ], as did ours. This seems likely as bile leaks are easy to detect by scintigraphy, for example, tracer accumulation in a nonphysiological site as shown in Figure 2 .…”

Section: Discussionsupporting

confidence: 81%

“…Another study showed significant negative influence of hyperbilirubinemia (>5 mg/dL) on the diagnosis provided by the HBS in patients who underwent orthotopic liver transplantation [ 16 ]. A correlation between elevated total bilirubin and the final diagnosis could be observed in neither LTX patients nor in liver-resected patients.…”

Section: Discussionmentioning

confidence: 99%

“…There has not yet been a study investigating differences in the usefulness of HBS between liver transplanted and liver-resected patients. Moreover, the role of hyperbilirubinemia and its impact on cholescintigraphic scans remain unclear, as a study found bilirubin to have a negative influence on the diagnosis provided by HBS [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of Hepatobiliary Scintigraphy after Liver Transplantation and Liver Resection

Eckenschwiller

Ackermann

Bechstein

et al. 2016

International Journal of Molecular Imaging

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Background and Aims. Biliary complications are the most frequent complications after common liver surgeries. In this study, accuracy of hepatobiliary scintigraphy (HBS) and impact of hyperbilirubinemia were evaluated. Methods. Between November 2007 and February 2016, 131 patients underwent hepatobiliary scintigraphy after having liver surgery. 39 patients with 42 scans after LTX (n = 13) or hepatic resection (n = 26) were evaluated in the study; 27 were male, with mean age 60 years. The subjects underwent hepatobiliary scintigraphy with Tc-99m labeled Mebrofenin. The results were compared to ERCP as gold standard performed within one month after HBS. We calculated sensitivity, specificity, PPV, and NPV. We compared LTX patients to patients with other liver surgeries. Furthermore the influence of hyperbilirubinemia on HBS scans was evaluated. Results. HBS always provided the correct diagnosis in cases of bile leak in the liver-resected group (14/14). Overall diagnostic accuracy was 76% (19/25) in this group and 54% (7/13) in the LTX group. False negative (FN) diagnoses occurred more often among LTX patients (p = 0.011). Hyperbilirubinemia (>5 mg/dL) significantly influenced the excretion function of the liver, prolonging HBS's time-activity-curve (p = 0.001). Conclusions. Hepatobiliary scintigraphy is a reliable tool to detect biliary complications, but reduced accuracy must be considered after LTX.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Accuracy of Hepatobiliary Scintigraphy after Liver Transplantation and Liver Resection

Eckenschwiller

Ackermann

Bechstein

et al. 2016

International Journal of Molecular Imaging

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“…rejection, CMV-hepatitis) a liver biopsy might be useful. Additional investigations like hepatobiliary scintigraphy (HIDA-scan) have been described with controversial results (16) and are rarely used in the routine workup nowadays (17).…”

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

257

233

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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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“…Reports on the use of a HIDA scan in liver transplant recipients yield conflicting results. 10,11 We aimed to use a HIDA scan in evaluating severe cholestasis in the immediate posttransplant period (7-30 d), and to try to develop an algorithm where the combination of a HIDA and clinical information can guide biliary intervention in these patients. Of the 25 ERCPs, 9 had a decrease of more than a 50% decrease in serum bilirubin mobile after ERCP, 6 patients had a decrease of more than 50% in serum bilirubin mobile after stent placement during ERCP.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Nair

Lingala

Eason

et al. 2014

Exp Clin Transplant

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Objectives: Severe cholestasis after liver transplant is common. In this study, our aim was to develop an algorithm to guide biliary intervention in these patients. Materials and Methods: A retrospective review was performed on patients who had undergone a hepatobiliary scan, with or without subsequent endoscopic retrograde cholangiogram, during the immediate postoperative period. These findings were evaluated along with laboratory values to determine the benefit for this evaluative process. Biliary duct obstruction was defined as > than a 50% reduction in serum bilirubin within 48 hours of endoscopic retrograde cholangiogram intervention. Results: Twelve patients had endoscopic retrograde cholangiogram with 6 stents in 25 patients with normal a hepatobiliary scan, and 2 patients met criteria for biliary duct obstruction. Twenty-two patients had endoscopic retrograde cholangiogram with 14 stents in 32 patients with delayed uptake, suggesting hepatocellular dysfunction on a hepatobiliary scan, and 4 patients met criteria for biliary duct obstruction. In the 57 patients with severe hyperbilirubinemia, 6 patients (11%) had biliary duct obstruction as a cause. Among the 34 endoscopic retrograde cholangiograms performed, 17% had biliary obstruction. On multivariate analysis, patients having both serum aspartate transaminase concentrations < 1500 IU/L and serum total bilirubin levels > 257 μmol/L had an odds ratio of 25.1 for predicting biliary obstruction (95% CI: 6-37; P = .002). Conclusions: A hepatobiliary scan with a combination peak serum aspartate transaminase and peak serum total bilirubin levels offer a valuable tool to identify patients with hepatocellular dysfunction and can avoid endoscopic retrograde cholangiogram in the immediate posttransplant period.

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Tc-99m-BrIDA hepatobiliary (HIDA) scan has a low sensitivity for detecting biliary complications after orthotopic liver transplantation in patients with hyperbilirubinemia

Cited by 11 publications

References 18 publications

Accuracy of Hepatobiliary Scintigraphy after Liver Transplantation and Liver Resection

Accuracy of Hepatobiliary Scintigraphy after Liver Transplantation and Liver Resection

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

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