THE RADIOLOGICAL MANAGEMENT OF BILIARY COMPLICATIONS FOLLOWING LIVER-TRANSPLANTATION

Purpose: Biliary complications contribute significantly to morbidity a nd mortality in the liver transplant recipient. Surgery has been the m ainstay of therapy, but interventional radiological techniques have ma de significant progress.Methods: Diagnostic percutaneous transhepatic cholangiography (PTC) was performed in 12 patients; percutaneous trans hepatic drainage (PTD) was performed in 10 patients. Additional interv entional procedures included laser lithotripsy, biopsy, dilatation, an d stent implantation. Results: In 6 patients PTC revealed anastomotic, and in 6 patients nonanastomotic biliary strictures. Four patients ha d intrahepatic stones. Biliary strictures were treated by implantation of Palmaz stents in 5 of 6 patients with anastomotic strictures, and in 3 of 6 patients with nonanastomotic strictures. The intrahepatic st ones were fragmented with dye laser lithotripsy under cholangioscopic control in 3 of 4 patients. One spontaneous stent migration after 24 m onths and one stent occlusion were observed, the remaining stents are still patent. Patients with anastomotic strictures had a more favorabl e outcome: 5 of 6 of these patients are still alive and symptom-free a fter an average of 27.4 months, but only 3 of 6 patients with nonanast omotic strictures are alive after an average of 9.8 months. Conclusion : The different outcomes in patients with anastomotic versus nonanasto motic strictures may be explained by the different causes of these typ es of stricture.