The predictive value of transabdominal ultrasonography in the diagnosis ofbiliary tract complications after orthotopic liver transplantation

Background-In transplant recipients with choledococholedocostomy (CDCD), en doscopic retrograde cholangiopancreatography (ERCP) remains the gold standa rd for the diagnosis of biliary leak or strictures. Transabdominal ultrason ography (TAUS) has been used to screen patients with suspected biliary trac t complications, prior to ERCP, although the clinical effectiveness remains unclear. Aims-To assess-the predictive value of TAUS in the diagnosis of biliary tra ct complications after liver transplantation. Methods-144 consecutive ERCP and corresponding ultrasonogram reports perfor med 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 tra ct abnormalities were found at TAUS in 49 (64%) of the 77 patients. TAUS ha d an overall sensitivity of 77%, and specificity of 67%, with positive and negative predictive values of 26% and 95% respectively, when adjusted for t he 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 r eduction 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 p resence of biliary complications unlikely.