Ischemic-type biliary lesions without hepatic artery occlusion after liver transplantation: early diagnosis of cholangiography

Abstract

Objective To evaluate the value of cholangiography for early diagnosis of ischemic-type biliary lasions(ITBL) after liver transplantation. Methods Two hundred and fifty-three patients with liver transplantaion between Jan 2004 and Oct 2006 were recruited. Initial cholangiography was compared with terminal cholangiography to evaluate the value of initial cholangiography of ITBL. The t test, Chi-square test, sum rank test were used for statistics. Results Based on initial cholangiography, 189 patients were diagnosed with normal appearance, while 64 patients were diagnosed with abnormal appearance. The abnormal initial cholangiography appearances included poor filling in 33 patients and irregularity in 31 patients. Based on terminal cholangiogruphy, 199 patients were diagnosed with normal appearance and 54 patients with ITBL In patients with abnormal initial cholangiography, ITBL was occurred in 39 of 64 patients including 10 of 33 poor frlling patients and 29 of 31 irregularity patients. In patients with normal initial appearance, ITBL was only occurred in 15 of 189 patients. The abnormal initial cholangiography was associated with ITBL significantly (X2 = 79.999, P = 0.000, r = 0.490). Initial cholangiography had an overall sensitivity of 72.22%, and specificity of 87.44%, with positive and negative predictive values of 60.94% and 92.06%, respectively. The abnormal initial cholangiogruphy was a risk factor of ITBL by logistic regression analyses(OR=15.193, P=0.000). Conclusion The abnormal initial cholangiography is associated with ITBL Initial cholangiography, especially minimal irregular of intrabepatic biliary tract, is a sensitive and specific method for the detection of ITBL after liver transplantation. Key words: Bila duct diseases; Ischemia; Cholangiography; liver transplantation