SEVERE ISCHEMIC-TYPE BILIARY STRICTURES DUE TO HEPATIC-ARTERY OCCLUSION 7 YEARS AFTER LIVER-TRANSPLANTATION - A RARE CAUSE OF LATE CHOLESTATIC GRAFT FAILURE

Although ischemic cholangitis is an important cause of early cholestat ic graft failure in hepatic allografts, it rearly leads to biliary tra ct abnormalities in the late postoperative period. We describe a 54-ye ar-old woman who underwent orthotopic liver transplantation for alcoho lic liver cirrhosis in 1988 and presented in April of 1995 with malais e, jaundice, dark urine, clay-colored stools and cholestasis. An endos copic retrograde cholangiopancreatography demonstrated a rapid progres sive sclerosing cholangitis. Liver biopsy findings showed mild portal hepatitis, specimens were non-diagnostic with regard to cholangitis, a nd no infection was found, Duplex ultrasonography suggested obstructio n of hepatic artery blood flow and celiac arteriogram confirmed comple te hepatic arterial occlusion. Progressive destruction and irregular s tricturing and dilatation of the intra- and extrahepatic biliary tree, complicating ascending infectious cholangitis, progressive cholestati c jaundice and insufficient endoscopic biliary drainage made a hepatic retransplantation in 1995 mandatory. Ischemic cholangitis is an impor tant cause of cholestatic graft failure, but this type of cholangitis is difficult to diagnose because of its misleading biopsy manifestatio ns. We conclude that liver transplant recipients who exhibit non-anast omotic strictures on cholangiography should be evaluated for occlusion of the hepatic artery as a possible cause.