The value of routine cholangiography on the diagnosis of biliary tract complications after liver transplantation

Background: The real incidence of biliary tract complications (BTCs) after liver transplantation (LT) is inaccurate due to the absence of a systematic post-transplant screening protocol. Furthermore, early diagnosis of BTCs can favor endoscopic or radiological treatment, keeping surgical treatment to advanced cases. Here, we review our clinical policy to perform a routine cholangiography within 6mo post- LT on the diagnosis of BTCs. Patients/Methods: Two-hundred fifty-five patients transplanted from January 2000 to April 2009 were included in the present study. Duct-to-duct biliaryanastomosis was performed in 225 patients (66 with T-tube), and 30 underwent a hepatico-jejunostomy. Our policy included a trans T-tube cholangiography (TTC) performed at any time per clinical indication or at 3mo post-LT before T-tube ablation. Percutaneous cholangiography (PTC) was routinely performed at 6mo post-LT or when indicated. Cholangiographic results were reviewed and correlated with patients clinical and biochemistry presentation. Results: From 30 clinically indicated cholangiographies, 22 detected a BTC (73%), when in the 229 routine exams, 59 were positive (25,8%). Positive routine exams correlation with clinical and biochemistry presentation showed that 14 (23,7%) patients had abnormal liver tests, 2 were only symptomatic, 9 had clinical and abnormal liver tests, and 57.6% (34) of all patients were asymptomatic and without biochemistry alteration. Thirty-five patients were treated, mainly by endoscopic procedures or interventional radiology. Twenty-four patients with less than 50% of diameter narrowing were only observed and no later-BTCs were observed. Routine exams complication rate was 3,08% (8/259) with no mortality. Only 9 out 170 patients with normal PTC at 6mo developed late BTCs (120mo follow-up, range 8-204). Conclusion: The incidence of asymptomatic BTCs diagnosed on routine cholangiographies was greater than expected, corresponding for more than half of cases. Furthermore two-thirds of those patients required BTCs treatment. Systematic post-LT cholangiography is an important tool on the diagnostic of such lesions