Abstract
Background and Study Aims: Diagnostic imaging of the biliary tract is often required in liver transplant reciplents,
preoperatively to assess extent of biliary tract disease and postoperatively in patients
with a suspected biliary complication due to an abnormal postoperative course.
Patients and Methods: Over a six-year period, 115 patients received 127 liver transplantations at our institution.
Twenty-three preoperative ERCPs were performed in 17 patients, while 25 ERCPs were
performed on 15 patients after liver transplantation.
Results: Preoperative ERCP in seven of 17 patients revealed a dominant biliary stricture as
a result of primary sclerosing cholangitis (PSC); five of these patients were managed
successfully with the placement of biliary endoprosthesis. An additional nine patients
with PSC underwent brush cytology of the extrahepatic bile ducts to rule out coexisting
cholangiocarcinoma; there were no positive results, although three were found to have
coexisting cholangiocarcinoma after examination of the explanted liver. Postoperatively,
nine of 15 patients were found to have biliary tract disease. These included five
biliary strictures (three treated successfully by endoscopic dilation and stent therapy),
two biliary leaks (treated by biliary endoprosthesis), one biloma (treated by percutaneous
drainage) and one intraductal stone (treated successfully by sphincterotomy and stone
extraction). The remaining six patients showed no abnormality at ERCP, and were subsequently
diagnosed with allograft rejection.
Conclusions: Diagnosis of biliary complications after hepatic transplantation is often problematic.
Definitive characterization frequently requires cholangiography. Interventional biliary
procedures, both endoscopic and percutaneous, can be used successfully to treat these
complications; however, surgical revision and retransplantation are sometimes required.
