Observational Study
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World J Gastroenterol. Sep 7, 2014; 20(33): 11856-11864
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11856
Role of multi-detector computed tomography for biliary complications after liver transplantation
Xiao-Chun Meng, Wen-Sou Huang, Pei-Yi Xie, Xiu-Zhen Chen, Ming-Yue Cai, Hong Shan, Kang-Shun Zhu
Xiao-Chun Meng, Wen-Sou Huang, Pei-Yi Xie, Xiu-Zhen Chen, Ming-Yue Cai, Hong Shan, Kang-Shun Zhu, Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Meng XC, Shan H and Zhu KS designed research; Meng XC, Huang WS, Xie PY, Chen XZ, Cai MY and Zhu KS performed research; Xie PY and Cai MY performed statistical analysis; Meng XC and Zhu KS wrote the paper.
Supported by National Natural Science Foundation of China, No. 81201090, No. 81371655; Guangdong Natural Science Foundation, No. S2012010008367
Correspondence to: Kang-Shun Zhu, MD, Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. zhksh010@163.com
Telephone: +86-20-85252066 Fax: +86-20-85252616
Received: February 19, 2014
Revised: April 29, 2014
Accepted: May 25, 2014
Published online: September 7, 2014
Processing time: 200 Days and 2.5 Hours
Abstract

AIM: To investigate the diagnostic performance of multi-detector computed tomography (MDCT) in detecting biliary complications after orthotopic liver transplantation (OLT).

METHODS: Eighty-three consecutive OLT recipients, who presented with clinical or biochemical signs of biliary complications, underwent MDCT examination. Two experienced radiologists assessed MDCT images in consensus to determine biliary complications. Final confirmation was based on percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography in 58 patients, surgery in four patients, liver biopsy in 10, and clinical and sonography follow-up in 11 patients.

RESULTS: Biliary complications were eventually confirmed in 62 of 83 patients (74.7%), including anastomotic biliary strictures in 32, nonanastomotic biliary strictures in 21, biliary stones in nine (5 with biliary strictures), anastomotic bile leak in five, and biloma in six (all with nonanastomotic strictures, and 2 with biligenic hepatic abscess). Twenty-one patients had no detection of biliary complications. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MDCT for detecting biliary strictures were 90.6%, 86.7%, 89.2%, 92.3% and 83.9%, respectively. For detecting biliary stones, anastomotic bile leak and biloma, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MDCT were all 100%.

CONCLUSION: MDCT is a useful screening tool for detecting biliary complications after OLT.

Keywords: Liver; Transplantation; Biliary; Complications; Computed tomography

Core tip: The value of multi-detector computed tomography (MDCT) in detecting biliary complications after orthotopic liver transplantation (OLT) is conflicting. This study, with 83 OLT recipients suspected of biliary complications, suggests that MDCT is a useful screening tool for detecting biliary complications after OLT. MDCT presented a sensitivity of 90.6% and specificity of 86.7% for biliary strictures, and both sensitivity and specificity of 100% for biliary stones, anastomotic bile leak and biloma. So far, this is the largest sample population to investigate the diagnostic accuracy of MDCT for biliary complications after OLT, which will help us make a treatment decision.