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Copyright ©2014 Baishideng Publishing Group Inc.
World J Radiol. Jul 28, 2014; 6(7): 424-436
Published online Jul 28, 2014. doi: 10.4329/wjr.v6.i7.424
Table 1 Overview of main biliary complications occurring after liver transplantation
Type ofcomplicationPrevalence in adultOLT patientsRisk factorsTime of onsetfrom OLTClinical featuresTreatment
Bile leak7.8% OLT 9.5% LDLTT-tube displacement or removal (T-tube leak) technical failure during surgery (anastomotic leak) HAT (nonanastomotic leak) Ischemic-related injury, immunologically-related injury, cytotoxic injury induced by bile salts (nonanastomotic leak in pts. without HAT)1-3 moFever, abdominal complaint, signs of cholestasis and or cholangitisLeaving the T-tube open (T-Tube leaks) ERC with Sphincterotomy and stent placement Percutaneous drainage
Anastomotic stricture13% OLT 19% LDLTOlder donor age Roux-en-Y choledochojejunostomy Technical factors (earlier manifestation) Ischemia of the donor bile duct (earlier manifestation) Previous anastomotic leakage (late manifestation)within 6 mo-1 yr, occasionally laterBiliary obstructionSurgical revision (repair or conversion to bilio-enteric anastomosis) ERC with balloon dilatation and stent placement (usually repeated procedures) Surgical revision (conversion to bilio-enteric anastomosis)
NAS5%-25%HAT Microangiopathic injury (prolonged warm or cold ischemia times of the graft) (ITBL) Immunogenic injury (AB0 incompatibility between donor and recipient, chronic ductopenic rejection, primitive sclerosing cholangitis) (ITBL) Cytotoxic injury by bile salts (ITBL)Within 6 mo (HAT-associated NAS) After 6 mo (ITBL)Cholestasis with recurrent cholangitisBiliary toilette, dilatation ± stent placement via ERC/PTC Medical therapy (ursodeoxycholic acid and antibiotics if recurrent cholangitis)
Stones, casts and sludge5.70%Anastomotic and nonanastomotic biliary strictures Presence of T-tube or stent Hepaticojejunostomy Ischemia Infectious alteration in bile compositionWithin 1 yr (casts and sludge) After 1 yr (stones)Biliary obstructionConversion to hepaticojejunostomy(rarely) Retransplantation Bile ducts toilette using ERC/PTC Medical therapy with ursodeoxycholic acid Retransplantation
Sphincter of Oddi dysfunction and papillary stenosis2%-7%Denervation of the recipient common bile duct leading to sphincter of Oddi spasm Inflammation and/or scarring of the sphincter of Oddi6 mo to 1 yrIncreased cholestatic enzymesEndoscopic sphincterotomy
Table 2 Results of previous systematic reviews on the role for magnetic resonance cholangiography in assessing biliary complications after orthotopic liver transplantation
Jorgensen et al[1]Xu et al[55]
GoalBiliary obstructionAll biliary complicationsSubset of strictures
Pooled sensitivity96.0% (0.92%-0.98%)0.95% (0.92%-0.97%)0.94% (0.88%-0.98%)
Pooled specificity0.94% (0.90%-0.97%)0.92% (0.89%-0.94%)0.95% (0.88%-0.99%)
Pooled PLR17.00 (9.4-29.6)10.23 (6.21-16.84)9.96 (2.52-39.36)
Pooled NLR0.04 (0.02-0.08)0.08 (0.06-0.12)0.09 (0.04-0.17)