Hepatobiliary Scintigraphy to Evaluate Biliary Complications of Pediatric Liver Transplantation: An Account of an Experience

Abstract

Introduction Hepatobiliary scintigraphy (HS) is a noninvasive imaging technique whose use in the follow-up of liver transplantation has not been duly documented. The main objective of this study is to describe the experience of using this technique to detect biliary complications in pediatric patients following liver transplantation.

Materials and Methods A retrospective, observational, and descriptive study involving 86 pediatric patients who had undergone liver transplantation between 2013 and 2018. Of the 86, 31 had undergone at least one HS during their postoperative period.

Results A total of 45 studies were performed on 31 patients (36% of the patients undergoing transplantation during that time period). Patient ages ranged from 5 to 204 months (mean = 50 months). A total of 22 transplants (71%) were from living donors and 9 (29%) were from cadaveric donors. Of the 45 studies, 22 were positive for biliary complications, and all of them had an impact on clinical decision-making. The remaining 23 studies were negative. Of these 23, 19 continued under medical treatment and the other four underwent an additional intervention with positive surgical outcomes in all cases. All scintigraphy studies revealed hepatocellular dysfunction and cholestasis.

Conclusion The HS is a useful, noninvasive, and diagnostic procedure for the early diagnosis of biliary complications that may impact the evolution of disease in liver transplant patients. It allows the treating physician to make a more informed decision regarding expectant management, surgical management, or a less invasive course of action for transplantation complications.

Keywords

hepatobiliary scintigraphy - pediatric liver transplantation - biliary complications

Publication History

Received: 24 June 2020

Accepted: 11 November 2020

Article published online:
30 December 2020

• References

• 1 Banzo I, Tabuenca O, Gómez-Barquín R, Blanco I, Quirce R, Carril J. La gammagrafía hepatobiliar en los pacientes con trasplante hepático y sospecha de fuga biliar. Rev Esp Med Nucl 1996; 15: 3-10
• 2 Gencoglu EA, Kocabas B, Moray G, Aktas A, Karakayali H, Haberal M. Usefulness of hepatobiliary scintigraphy for the evaluation of living related liver transplant recipients in the early postoperative period. Transplant Proc 2008; 40 (01) 234-237
• 3 Lambie H, Cook AM, Scarsbrook AF, Lodge JP, Robinson PJ, Chowdhury FU. Tc99m-hepatobiliary iminodiacetic acid (HIDA) scintigraphy in clinical practice. Clin Radiol 2011; 66 (11) 1094-1105
• 4 Lovinfosse P, Hustinx R. Nuclear medicine techniques in transplantation. Clin Transl Imaging 2017; 5: 45-62
• 5 Ryu CH, Lee SK. Biliary strictures after liver transplantation. Gut Liver 2011; 5 (02) 133-142
• 6 Shah AN, Dodson F, Fung J. Role of nuclear medicine in liver transplantation. Semin Nucl Med 1995; 25 (01) 36-48
• 7 Feier FH, da Fonseca EA, Seda-Neto J, Chapchap P. Biliary complications after pediatric liver transplantation: risk factors, diagnosis, and management. World J Hepatol 2015; 7 (18) 2162-2170
• 8 Goss JA, Shackleton CR, McDiarmid SV. et al. Long-term results of pediatric liver transplantation: an analysis of 569 transplants. Ann Surg 1998; 228 (03) 411-420
• 9 Kim JS, Moon DH, Lee SG. et al. The usefulness of hepatobiliary scintigraphy in the diagnosis of complications after adult-to-adult living donor liver transplantation. Eur J Nucl Med Mol Imaging 2002; 29 (04) 473-479
• 10 Darius T, Rivera J, Fusaro F. et al. Risk factors and surgical management of anastomotic biliary complications after pediatric liver transplantation. Liver Transpl 2014; 20 (08) 893-903
• 11 Hopkins LO, Feyssa E, Parsikia A. et al. Tc-99m-BrIDA hepatobiliary (HIDA) scan has a low sensitivity for detecting biliary complications after orthotopic liver transplantation in patients with hyperbilirubinemia. Ann Nucl Med 2011; 25 (10) 762-767
• 12 Gabrielli M, Norero E, Figueroa E. et al. Incidencia, factores de riesgo y tratamiento de las complicaciones biliares del trasplante hepático. Rev Chil Cir 2010; 62: 355-361
• 13 Gunawansa N, McCall JL, Holden A, Plank L, Munn SR. Biliary complications following orthotopic liver transplantation: a 10-year audit. HPB (Oxford) 2011; 13 (06) 391-399
• 14 Northover JM, Terblanche J. A new look at the arterial supply of the bile duct in man and its surgical implications. Br J Surg 1979; 66 (06) 379-384
• 15 Seehofer D, Eurich D, Veltzke-Schlieker W, Neuhaus P. Biliary complications after liver transplantation: old problems and new challenges. Am J Transplant 2013; 13 (02) 253-265
• 16 Al Sofayan MS, Ibrahim A, Helmy A, Al Saghier MI, Al Sebayel MI, Abozied MM. Nuclear imaging of the liver: is there a diagnostic role of HIDA in posttransplantation?. Transplant Proc 2009; 41 (01) 201-207
• 17 Concannon RC, Howman-Giles R, Shun A, Stormon MO. Hepatobiliary scintigraphy for the assessment of biliary strictures after pediatric liver transplantation. Pediatr Transplant 2009; 13 (08) 977-983
• 18 Tripathi M, Chandrashekar N, Kumar R. et al. Hepatobiliary scintigraphy. An effective tool in the management of bile leak following laparoscopic cholecystectomy. Clin Imaging 2004; 28 (01) 40-43
• 19 Potthoff A, Hahn A, Kubicka S. et al. Diagnostic value of ultrasound in detection of biliary tract complications after liver transplantation. Hepat Mon 2013; 13 (01) e6003
• 20 Palaniswamy SS, Subramanyam P. Bile leak leading to lesser sac bile collection masquerading as stomach in hepatobiliary scintigraphy. J Clin Exp Hepatol 2014; 4 (03) 276-278
• 21 Kurzawinski TR, Selves L, Farouk M. et al. Prospective study of hepatobiliary scintigraphy and endoscopic cholangiography for the detection of early biliary complications after orthotopic liver transplantation. Br J Surg 1997; 84 (05) 620-623
• 22 Vélez-Gutierrez C, Gutierrez-Villamil C, Arevalo-Leal S, Mejía-Hernandez G, Marín-Oyaga V. Hepatobiliary scintigraphy in the study of complications in adult patients after liver transplant. Description of the experience. Rev Esp Med Nucl Imagen Mol 2019; 38 (04) 207-211