Ultrasonography, laboratory, and cholangiography correlation of biliary complications in pediatric liver transplantation

Abstract

The aim of this study is to correlate the US, laboratory, and cholangiography findings in pediatric liver transplant patients with biliary complications, trying to identify reliable decision-making tools for the management of these complications. Retrospective review was carried out of US results in 39 consecutive patients, from 2011 to 2013, with biliary complications after LT, documented by PTC. According to US biliary dilation, patients were classified as: mild, moderate, and severe, and according to laboratory findings as: normal or abnormal serum bilirubin and level of serum GGT. Data were correlated with PTC findings, divided in three groups: mild, moderate, and severe/occlusive BDS. There was no statistically significant correlation between the US findings and the laboratory findings and between US findings with PTC. There was a statistically significant correlation between GGT and cholangiography. In our series, abnormal US could not predict the severity of BDS on PTC. Bilirubin results were not able to predict the US findings either. GGT results demonstrated a statistically significant correlation with the severity of BDS found on PTC. These findings emphasize the role of GGT in the evaluation and decision of biliary interventions in pediatric liver transplant recipients.

Subclinical biliary strictures as a cause of long-term allograft dysfunction in children who underwent liver transplantation

“…The development of intrahepatic bile duct dilatation may take several months before being detectable on US when a significant anastomotic stricture occurs. 4,18,[22][23][24][25][26][27] In children after LT, Feier et al demonstrated that 70% of the patients with BS had normal US findings, 7 in agreement with our results where 45% of the patients had normal US, with a PPV of 87% but very low sensitivity (57.1%).…”

“…The accuracy of ultrasound (US) to make the diagnosis of BS varies widely in the literature and ranges from 25% to 95%. The development of intrahepatic bile duct dilatation may take several months before being detectable on US when a significant anastomotic stricture occurs 4,18,22‐27 …”

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 …”

Split liver transplantation: Report of right and left graft outcomes from a multicenter Argentinean group

“…Regarding complications, biliary complications were the ones most frequently observed in LSG and RSG. Currently, these complications are routinely managed using percutaneous or endoscopic procedures both in pediatric and in adult LT and are therefore considered to be treatable and transient …”