Mustafa Fatih ARSLAN, Nuray HALİLOĞLU, Ayşe ERDEN

MR cholangiopancreatography findings of biliary tract complications after liver transplantation

Background/aim: We aimed to present the magnetic resonance cholangiopancreatography (MRCP) findings of biliary tract complications after liver transplantation. Materials and methods: Seventy-five patients who underwent MRCP in our department between July 2011 and July 2015 after liver transplantation were retrospectively evaluated. The MRCP images were reevaluated by three radiologists in consensus. Diagnostic confirmation of MRCP findings was obtained with direct cholangiographic examinations or with clinical, radiological, and laboratory findings and concordance between MRCP findings and the final diagnosis was investigated. Results: Twenty-seven of the 75 patients had normal MRCP findings and at least one type of biliary tract complication was detected on the MR images of 48 patients. These complications included anastomotic stricture, dilatation of the biliary tract, nonanastomotic stricture, biliary leakage, cholangitis, biloma, abscess due to cholangitis, biliary stone-sludge, and donor-to-recipient bile duct disproportion. Thirty of the 75 patients were followed only by clinical and laboratory findings without further imaging. Forty-five patients underwent direct cholangiographic examinations. At the end of the follow-up period, 28 of the 75 patients were considered free of biliary tract complications, and at least one bile duct complication was diagnosed in 47 patients. Conclusion: With its high sensitivity and specificity, MRCP should be the first choice of method in the diagnosis and follow-up of biliary complications after liver transplantation.

Keywords:

Liver transplantation, biliary tract complications, magnetic resonance cholangiopancreatography,

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Girometti R, Cereser L, Como G, Zuiani C, Bazzocchi M. Biliary complications after orthotopic liver transplantation: MRCP findings. Abdom Imaging 2008; 33: 542-554.
Valls C, Alba E, Cruz M, Figueras J, Andia E, Sanchez A, Lladó L, Serrano T. Biliary complications after liver transplantation: diagnosis with MR cholangiopancreatography. Am J Roentgenol 2005; 184: 812-820.
Vitellas KM, Keogan MT, Spritzer CE, Nelson RC. MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. Radiographics 2000; 20: 939-957.
Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909-918.
Keogan MT, Edelman RR. Technologic advances in abdominal MR imaging. Radiology 2001; 220: 310-320.
Xu YB, Min ZG, Jiang HX, Qin SY, Hu BL. Diagnostic value of magnetic resonance cholangiopancreatography for biliary complications in orthotopic liver transplantation: a meta- analysis. Transplant Proc 2013; 45: 2341-2346.
Beltran MM, Marugan RB, Oton E, Blesa C, Nuno J. Accuracy of magnetic resonance cholangiography in the evaluation of late biliary complications after orthotopic liver transplantation. Transplant Proc 2005; 37: 3924-3925.
Katz LH, Benjaminov O, Belinki A, Geler A, Braun M, Knizhnik M, Aizner S, Shaharabani E, Sulkes J, Shabtai E et al. Magnetic resonance cholangiopancreatography for the accurate diagnosis of biliary complications after liver transplantation: comparison with endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography - long-term follow-up. Clin Transplant 2010; 24: E163-169.
Zajko AB, Campbell WL, Logsdon GA, Bron KM, Tzakis A, Esquivel CO, Starzl TE. Cholangiographic findings in hepatic artery occlusion after liver transplantation. Am J Roentgenol 1987; 149: 485-489.
Greif F, Bronsther OL, Van Thiel DH, Casavilla A, Iwatsuki S, Tzakis A, Todo S, Fung JJ, Starzl TE. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg 1994; 219: 40-45.
Friedman A, Dachman A. Radiology of the Liver, Biliary Tract and Pancreas. St. Louis, MO, USA: Mosby; 1994.
Guibaud L, Bret PM, Reinhold C, Atri M, Barkun AN. Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography. Radiology 1995; 197: 109-115.
Garcia-Criado A, Gilabert R, Bargallo X, Bru C. Radiology in liver transplantation. Semin Ultrasound CT MR 2002; 23: 114- 129.
Seehofer D, Eurich D, Veltzke-Schlieker W, Neuhaus P. Biliary complications after liver transplantation: old problems and new challenges. Am J Transplant 2013; 13: 253-265.
Kawachi S, Shimazu M, Wakabayashi G, Hoshino K, Tanabe M, Yoshida M, Morikawa Y, Kitajima M. Biliary complications in adult living donor liver transplantation with duct-to-duct hepaticocholedochostomy or Roux-en-Y hepaticojejunostomy biliary reconstruction. Surgery 2002; 132: 48-56.
Rerknimitr R, Sherman S, Fogel EL, Kalayci C, Lumeng L, Chalasani N, Kwo P, Lehman GA. Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy. Gastroint Endosc 2002; 55: 224- 231.
Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV. Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiographics 2009; 29: 1725-1748.