Abstract
BACKGROUND—In transplant recipients with choledococholedocostomy (CDCD), endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for the diagnosis of biliary leak or strictures. Transabdominal ultrasonography (TAUS) has been used to screen patients with suspected biliary tract complications, prior to ERCP, although the clinical effectiveness remains unclear. AIMS—To assess the predictive value of TAUS in the diagnosis of biliary tract complications after liver transplantation. METHODS—144 consecutive ERCP and corresponding ultrasonogram reports performed over a 67 month period in 79 patients after liver transplantation were analysed retrospectively. RESULTS—77 ERCP patients had both a TAUS and a successful ERCP. Biliary tract abnormalities were found at TAUS in 49 (64%) of the 77 patients. TAUS had an overall sensitivity of 77%, and specificity of 67%, with positive and negative predictive values of 26% and 95% respectively, when adjusted for the prevalence rate of biliary complications after liver transplantation of 12.8% in our population. The use of bile duct calibre as sole criterion for an abnormal scan improved the specificity (76%) and with a corresponding reduction in sensitivity (66%). The risk of false negative TAUS was similar in both the early and late post-transplant periods. CONCLUSIONS—A normal TAUS after liver transplantation with CDCD makes the presence of biliary complications unlikely. Keywords: endoscopic retrograde cholangiopancreatography; transabdominal ultrasonography; orthotopic liver transplantation; predictive value; sensitivity; specificity
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- Altman D. G., Bland J. M. Diagnostic tests 2: Predictive values. BMJ. 1994 Jul 9;309(6947):102–102. doi: 10.1136/bmj.309.6947.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Evans R. A., Raby N. D., O'Grady J. G., Karani J. B., Nunnerley H. B., Calne R. Y., Williams R. Biliary complications following orthotopic liver transplantation. Clin Radiol. 1990 Mar;41(3):190–194. doi: 10.1016/s0009-9260(05)80966-3. [DOI] [PubMed] [Google Scholar]
- Gholson C. F., Zibari G., McDonald J. C. Endoscopic diagnosis and management of biliary complications following orthotopic liver transplantation. Dig Dis Sci. 1996 Jun;41(6):1045–1053. doi: 10.1007/BF02088217. [DOI] [PubMed] [Google Scholar]
- Greif F., Bronsther O. L., Van Thiel D. H., Casavilla A., Iwatsuki S., Tzakis A., Todo S., Fung J. J., Starzl T. E. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg. 1994 Jan;219(1):40–45. doi: 10.1097/00000658-199401000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kok T., Van der Sluis A., Klein J. P., Van der Jagt E. J., Peeters P. M., Slooff M. J., Bijleveld C. M., Haagsma E. B. Ultrasound and cholangiography for the diagnosis of biliary complications after orthotopic liver transplantation: a comparative study. J Clin Ultrasound. 1996 Mar-Apr;24(3):103–115. doi: 10.1002/(SICI)1097-0096(199603)24:3<103::AID-JCU1>3.0.CO;2-L. [DOI] [PubMed] [Google Scholar]
- Lerut J., Gordon R. D., Iwatsuki S., Esquivel C. O., Todo S., Tzakis A., Starzl T. E. Biliary tract complications in human orthotopic liver transplantation. Transplantation. 1987 Jan;43(1):47–51. doi: 10.1097/00007890-198701000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Morton M. J., James E. M., Wiesner R. H., Krom R. A. Applications of duplex ultrasonography in the liver transplant patient. Mayo Clin Proc. 1990 Mar;65(3):360–372. doi: 10.1016/s0025-6196(12)62536-1. [DOI] [PubMed] [Google Scholar]
- O'Connor H. J., Vickers C. R., Buckels J. A., McMaster P., Neuberger J. M., West R. J., Elias E. Role of endoscopic retrograde cholangiopancreatography after orthotopic liver transplantation. Gut. 1991 Apr;32(4):419–423. doi: 10.1136/gut.32.4.419. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rolles K., Dawson K., Novell R., Hayter B., Davidson B., Burroughs A. Biliary anastomosis after liver transplantation does not benefit from T tube splintage. Transplantation. 1994 Feb;57(3):402–404. doi: 10.1097/00007890-199402150-00015. [DOI] [PubMed] [Google Scholar]
- Rouch D. A., Emond J. C., Thistlethwaite J. R., Jr, Mayes J. T., Broelsch C. E. Choledochocholedochostomy without a T tube or internal stent in transplantation of the liver. Surg Gynecol Obstet. 1990 Mar;170(3):239–244. [PubMed] [Google Scholar]
- Sossenheimer M., Slivka A., Carr-Locke D. Management of extrahepatic biliary disease after orthotopic liver transplantation: review of the literature and results of a multicenter survey. Endoscopy. 1996 Sep;28(7):565–571. doi: 10.1055/s-2007-1005556. [DOI] [PubMed] [Google Scholar]
- Van Thiel D. H., Fagiuoli S., Wright H. I., Rodriguez-Rilo H., Silverman W. Biliary complications of liver transplantation. Gastrointest Endosc. 1993 May-Jun;39(3):455–460. doi: 10.1016/s0016-5107(93)70131-5. [DOI] [PubMed] [Google Scholar]
- Zajko A. B., Zemel G., Skolnick M. L., Bron K. M., Campbell W. L., Iwatsuki S., Starzl T. E. Percutaneous transhepatic cholangiography rather than ultrasound as a screening test for postoperative biliary complications in liver transplant patients. Transplant Proc. 1988 Feb;20(1 Suppl 1):678–681. [PubMed] [Google Scholar]
- Zemel G., Zajko A. B., Skolnick M. L., Bron K. M., Campbell W. L. The role of sonography and transhepatic cholangiography in the diagnosis of biliary complications after liver transplantation. AJR Am J Roentgenol. 1988 Nov;151(5):943–946. doi: 10.2214/ajr.151.5.943. [DOI] [PubMed] [Google Scholar]