[Biliary complications of liver transplant. Role of cholangiography with magnetic resonance].

INTRODUCTION

Orthotopic liver transplantation is considered the treatment of choice in several hepatic conditions. The five-year patient survival rate is approximately 75%, thanks to progress in both surgical techniques and postoperative medical treatment. Biliary complications are one of the commonest causes of failure and their prompt identification is difficult due to their insidious clinical pattern and to the poor predictive value of a negative US examination. To date, invasive contrast cholangiography (endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography) may be the only way to identify anatomic abnormalities and it is therefore a necessary examination when biliary obstruction is suspected. The aim of our work was to assess the possible role of MR cholangiography in late biliary complications of liver transplanted patients.

MATERIAL AND METHODS

Twenty-three liver transplant recipients (11 men and 12 women, mean age: 51.1 years) were submitted to MR cholanglography using non-breath-hold, fat-suppressed three-dimensional turbo spin echo sequences, (TR = 3000 ms, TE = 700 ms, ETL = 128). Our patients presented with clinical, laboratory and US patterns doubtful for biliary obstruction. The diagnostic confirmation was obtained at percutaneous transhepatic cholangiography (four cases), endoscopic retrograde cholangiography (eight cases), T-tube cholangiography (one case) or clinical follow-up (ten cases).

RESULTS

No biliary tract abnormalities were detected at MR cholangiography in 11 cases. Twelve strictures were diagnosed in eleven patients (9 anastomotic, two nonanastomotic/intrahepatic and one nonanastomotic/extrahepatic, with associated anastomotic and nonanastomotic strictures in two cases). MR cholangiography correctly defined the stricture site and the dilation of the bile ducts above in all cases, with optimal correlation with contrast cholangiographic findings. The common bile duct below the stricture was visible in 9 of 10 patients with extrahepatic strictures on MR cholangiography and in 8 of 10 patients on contrast cholangiograms. The distal common bile duct was missed on both MR cholangiography and diagnostic percutaneous transhepatic cholangiography in a patient only. The strictures were correctly graded in 8 of 10 patients, with two cases of overestimation. Other findings were a 1-cm stone proximal to the obstructed common bile duct, multiple intrahepatic stones in another case and common bile duct kinking at the anastomosis.

CONCLUSIONS

MR cholangiography is a useful imaging method in the follow-up of liver transplant recipients which can assess the biliary obstruction and therefore permit to limit the use of invasive procedure only for interventional purposes.