Magnetic resonance cholangiography in the assessment and management of biliary complications after OLT

Table 1 Overview of main biliary complications occurring after liver transplantation

Type ofcomplication	Prevalence in adultOLT patients	Risk factors	Time of onsetfrom OLT	Clinical features	Treatment
Bile leak	7.8% OLT 9.5% LDLT	T-tube displacement or removal (T-tube leak) technical failure during surgery (anastomotic leak) HAT (nonanastomotic leak) Ischemic-related injury, immunologically-related injury, cytotoxic injury induced by bile salts (nonanastomotic leak in pts. without HAT)	1-3 mo	Fever, abdominal complaint, signs of cholestasis and or cholangitis	Leaving the T-tube open (T-Tube leaks) ERC with Sphincterotomy and stent placement Percutaneous drainage
Anastomotic stricture	13% OLT 19% LDLT	Older donor age Roux-en-Y choledochojejunostomy Technical factors (earlier manifestation) Ischemia of the donor bile duct (earlier manifestation) Previous anastomotic leakage (late manifestation)	within 6 mo-1 yr, occasionally later	Biliary obstruction	Surgical revision (repair or conversion to bilio-enteric anastomosis) ERC with balloon dilatation and stent placement (usually repeated procedures) Surgical revision (conversion to bilio-enteric anastomosis)
NAS	5%-25%	HAT Microangiopathic injury (prolonged warm or cold ischemia times of the graft) (ITBL) Immunogenic injury (AB0 incompatibility between donor and recipient, chronic ductopenic rejection, primitive sclerosing cholangitis) (ITBL) Cytotoxic injury by bile salts (ITBL)	Within 6 mo (HAT-associated NAS) After 6 mo (ITBL)	Cholestasis with recurrent cholangitis	Biliary toilette, dilatation ± stent placement via ERC/PTC Medical therapy (ursodeoxycholic acid and antibiotics if recurrent cholangitis)
Stones, casts and sludge	5.70%	Anastomotic and nonanastomotic biliary strictures Presence of T-tube or stent Hepaticojejunostomy Ischemia Infectious alteration in bile composition	Within 1 yr (casts and sludge) After 1 yr (stones)	Biliary obstruction	Conversion to hepaticojejunostomy(rarely) Retransplantation Bile ducts toilette using ERC/PTC Medical therapy with ursodeoxycholic acid Retransplantation
Sphincter of Oddi dysfunction and papillary stenosis	2%-7%	Denervation of the recipient common bile duct leading to sphincter of Oddi spasm Inflammation and/or scarring of the sphincter of Oddi	6 mo to 1 yr	Increased cholestatic enzymes	Endoscopic sphincterotomy

Data from[5,11]. OLT: Orthotopic liver transplantation; NAS: Nonanastomotic strictures; ITBL: Ischemic-type biliary lesions; HAT: Hepatic artery thrombosis.

Table 2 Results of previous systematic reviews on the role for magnetic resonance cholangiography in assessing biliary complications after orthotopic liver transplantation

	Jorgensen et al[1]	Xu et al[55]
Goal	Biliary obstruction	All biliary complications	Subset of strictures
Pooled sensitivity	96.0% (0.92%-0.98%)	0.95% (0.92%-0.97%)	0.94% (0.88%-0.98%)
Pooled specificity	0.94% (0.90%-0.97%)	0.92% (0.89%-0.94%)	0.95% (0.88%-0.99%)
AUC	0.99	0.97	0.97
Pooled PLR	17.00 (9.4-29.6)	10.23 (6.21-16.84)	9.96 (2.52-39.36)
Pooled NLR	0.04 (0.02-0.08)	0.08 (0.06-0.12)	0.09 (0.04-0.17)

Number between parentheses represent the 95%CI. Analysis by Xu et al is stratified for the whole of complications and the subset of strictures. AUC: Area under the curve at Summary Receiving Operating Characteristic (SROC) curve; PLR: Positive likelihood ratio; NLR: Negative likelihood ratio.