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World J Gastroenterol. Aug 28, 2014; 20(32): 11080-11094
Published online Aug 28, 2014. doi: 10.3748/wjg.v20.i32.11080
Postoperative biliary adverse events following orthotopic liver transplantation: Assessment with magnetic resonance cholangiography
Piero Boraschi, Francescamaria Donati
Piero Boraschi, Francescamaria Donati, 2nd Unit of Radiology, Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, 56124 Pisa, Italy
Author contributions: Boraschi P searched the PubMed for relevant articles and wrote the draft manuscript; Donati F analyzed data, co-authored and critically revised the manuscript.
Correspondence to: Piero Boraschi, MD, 2nd Unit of Radiology, Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy. p.boraschi@do.med.unipi.it
Telephone: +39-050-996782 Fax: +39-178-2211474
Received: October 19, 2013
Revised: May 11, 2014
Accepted: May 23, 2014
Published online: August 28, 2014
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.

Keywords: Liver transplantation, Bile ducts, Biliary adverse events, Magnetic resonance cholangiography, Contrast-enhanced magnetic resonance cholangiography

Core tip: Biliary adverse events continue to be serious causes of morbidity, mortality, and transplant dysfunction or failure after orthotopic liver transplantation. In this article, we review the technique as well as the diagnostic role of magnetic resonance (MR) imaging with cholangiopancreatographic sequences in the assessment of adverse events following orthotopic liver transplantation. The features of the main types of biliary adverse events on MR cholangiopancreatography are presented and the recently developed techniques are also discussed in this setting, according to the biliary reconstruction and liver transplant procedure performed.