Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2016; 22(7): 2342-2348
Published online Feb 21, 2016. doi: 10.3748/wjg.v22.i7.2342
Risk factors of biliary intervention by imaging after living donor liver transplantation
Soon Kyu Lee, Jong Young Choi, Dong Myung Yeo, Young Joon Lee, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Dong Goo Kim, Young Kyoung You
Soon Kyu Lee, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Dong Myung Yeo, Young Joon Lee, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Dong Goo Kim, Young Kyoung You, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Author contributions: Lee SK performed the study and wrote the paper; Choi JY designed the study; Yeo DM and Lee YJ performed the study; Yoon SK, Bae SH and Jang JW collected the data; Kim HY, Kim DG and You YK analyzed the data.
Institutional review board statement: Approval from the Institutional Review Board of Seoul St. Mary’s Hospital (KC13RISI0788).
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jong Young Choi, MD, PhD, Professor, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea. jychoi@catholic.ac.kr
Telephone: +82-2-10-32714227 Fax: +82-2-5993589
Received: October 8, 2015
Peer-review started: October 9, 2015
First decision: November 5, 2015
Revised: November 14, 2015
Accepted: December 12, 2015
Article in press: December 12, 2015
Published online: February 21, 2016
Processing time: 114 Days and 12.9 Hours
Abstract

AIM: To determine the risk factors of biliary intervention using magnetic resonance cholangiopancreatography (MRCP) after living donor liver transplantation (LDLT).

METHODS: We retrospectively enrolled 196 patients who underwent right lobe LDLT between 2006 and 2010 at a single liver transplantation center. Direct duct-to-duct biliary anastomosis was performed in all 196 patients. MRCP images routinely taken 1 mo after LDLT were analyzed to identify risk factors for biliary intervention during follow-up, such as retrograde cholangiopancreatography or percutaneous transhepatic biliary drainage. Two experienced radiologists evaluated the MRCP findings, including the anastomosis site angle on three-dimensional images, the length of the filling defect on maximum intensity projection, bile duct dilatation, biliary stricture, and leakage.

RESULTS: Eighty-nine patients underwent biliary intervention during follow-up. The anastomosis site angle [hazard ratio (HR) = 0.48; 95% confidence interval (CI), 0.30-0.75, P < 0.001], a filling defect in the anastomosis site (HR = 2.18, 95%CI: 1.41-3.38, P = 0.001), and biliary leakage (HR = 2.52, 95%CI: 1.02-6.20, P = 0.048) on MRCP were identified in the multivariate analysis as significant risk factors for biliary intervention during follow-up. Moreover, a narrower anastomosis site angle (i.e., below the median angle of 113.3°) was associated with earlier biliary intervention (38.5 ± 4.2 mo vs 62. 1 ± 4.1 mo, P < 0.001). Kaplan-Meier analysis comparing biliary intervention-free survival according to the anastomosis site angle revealed that lower survival was associated with a narrower anastomosis site angle (36.3% vs 62.0%, P < 0.001).

CONCLUSION: The biliary anastomosis site angle in MRCP after LDLT may be associated with the need for biliary intervention.

Keywords: Magnetic resonance cholangiopancreatography; Liver transplantation; Living donor; Biliary intervention; Endoscopic retrograde cholangiopancreatography; Percutaneous transhepatic biliary drainage

Core tip: Biliary complications and interventions are common after living donor liver transplantation (LDLT). Identifying patients who are at high risk for biliary interventions early after LDLT could help clinicians with patient follow-up. Magnetic resonance cholangiopancreatography (MRCP) imaging was performed 1 mo after LDLT to determine risk factors for biliary intervention. The anastomosis site angle, a filling defect in the anastomosis site, and biliary leakage on MRCP were identified as significant risk factors. Moreover, a narrower anastomosis site angle was related to earlier biliary intervention. Here, for the first time, we have shown that the anastomosis site angle might be associated with the need for biliary intervention.