Hepatobiliary scintigraphy for detecting biliary strictures after living donor liver transplantation

Abstract

To investigate the diagnostic accuracy of hepatobiliary scintigraphy (HBS) in detecting biliary strictures in living donor liver transplantation (LDLT) patients. We retrospectively reviewed 104 adult LDLT recipients of the right hepatic lobe with duct-to-duct anastomosis, who underwent HBS and cholangiography. The HBS results were categorized as normal, parenchymal dysfunction, biliary obstruction, or bile leakage without re-interpretation. The presence of biliary strictures was determined by percutaneous cholangiography or endoscopic retrograde cholangiopancreatography (ERCP). In 89 patients with biliary strictures, HBS showed biliary obstruction in 50 and no obstruction in 39, for a sensitivity of 56.2%. Of 15 patients with no biliary strictures, HBS showed no obstruction in 11, for a specificity of 73.3%. The positive predictive value (PPV) was 92.6% (50/54) and the negative predictive value (NPV) was 22% (11/50). We also analyzed the diagnostic accuracy of the change in bile duct size. The sensitivity, NPV, specificity, and PPV were 65.2%, 27.9%, 80% and 95%, respectively. The absence of biliary obstruction on HBS is not reliable. Thus, when post-LDLT biliary strictures are suspected, early ERCP may be considered.