Early Postoperative MRCP for the Prediction of Biliary Stricture after Living Donor Liver Transplantation

Abstract

Introduction: Biliary strictures after liver transplantation remains a major cause of morbidity and mortality. The aim of the study was to identify factors on the early postoperative magnetic resonance cholangiography (MRC) for the prediction of biliary stricture following living donor liver transplantation (LDLT). Methods: From January 2008 to December 2010, 132 consecutive adult LDLT recipients who were evaluated with MRC at 3 weeks posttransplant as a routine posttransplant evaluation at our center were enrolled. All patients were imaged with the following sequences: axial T1-weighted and axial and coronal T2-weighted, 2D spin echo breath-hold radial cholangiography, and coronal 3D single-shot turbo spin echo with respiratory triggering. Patients underwent endoscpic retrograde cholangiography (ERCP) or percutaneous transhepatic cholangiography (PTC) when clinical, biochemical, or radiological evidence of biliary strictures. Results: Patients were followed up for a median period of 27.9 months. The biliary stricture was confirmed in 48 patients (36.3%). Twenty-nine patients underwent ERCP, and nineteen PTC. Median time from LT to biliary stricture was 131.5 days. In patients who develop biliary stricture, there was a statistically significant correlation between early posttransplant MRC and both ERCP and PTC findings. The predictive factors for the biliary stricture on the early posttransplant PTC was the severity of the stenosis, angle between the proximal and distal ducts, the size discrepancy between proximal and distal ducts, and intrahepatic duct dilatation. Conclusions: The biliary stricture following liver transplantation can be predicted by the MRC findings in the early posttransplant period, which may help with the prompt diagnosis when patients present with abnormal biochemical tests.