ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN THE ORTHOTOPIC LIVER-TRANSPLANT PATIENT

Background and Study Aims: Diagnostic imaging of the biliary tract is often required in liver transplant recipients, preoperatively to asses s extent of biliary tract disease and postoperatively in patients with a suspected biliary complication due to an abnormal postoperative cou rse. Patients and Methods: Over a six-year period, 115 patients receiv ed 127 liver transplantations at our institution. Twenty-three preoper ative ERCPs were performed in 17 patients, while 25 ERCPs were perform ed on 15 patients after liver transplantation. Results: Preoperative E RCP in seven of 17 patients revealed a dominant biliary stricture as a result of primary sclerosing cholangitis (PSC); five of these patient s were managed successfully,vith the placement of biliary endoprosthes is. An additional nine patients with PSC underwent brush cytology of t he extrahepatic bile ducts to rule out coexisting cholangiocarcinama; there were no positive results, although three were found to have coex isting cholangiocarcinoma after examination of the explanted liver. Po stoperatively, nine of 15 patients were found to have biliary tract di sease. These included five biliary strictures (three treated successfu lly by endoscopic dilation and stent therapy), two biliary leaks (trea ted by biliary endoprosthesis), one biloma (treated by percutaneous dr ainage) and one intraductal stone (treated successfully by sphincterot omy and stone extraction). The remaining six patients showed no abnorm ality at ERCP, and were subsequently diagnosed with allograft rejectio n. Conclusions: Diagnosis of biliary complications after hepatic trans plantation is often problematic. Definitive characterization frequentl y requires cholangiography. Interventional biliary procedures, both en doscopic and percutaneous, can be used successfully to treat these com plications; however, surgical revision and retransplantation are somet imes required.