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28 April 2017 : Original article  

Diagnostic Approach in Biliary Strictures After Pediatric Liver Transplantation

Dorota Jarzębicka1ABCDEF, Piotr Czubkowski1ABCDEF*, Anna Kamińska2BCDE, Małgorzata Markiewicz-Kijewska3BD, Katarzyna Nowak4BCD, Dorota Broniszczak3BD, Maciej Dądalski5CD, Irena Jankowska5ABDE, Joanna Pawłowska5ABDE

DOI: 10.12659/AOT.901931

Ann Transplant 2017; 22:257-264

Abstract

BACKGROUND: The diagnosis of post-liver transplant biliary strictures (BS) requires a high degree of clinical suspicion because of the diversity of symptoms and usually mild clinical presentation. If quickly treated, successful outcome is achieved most cases. The aim of our study was to analyze the value of diagnostic methods in BS after pediatric LTx.

MATERIAL AND METHODS: We retrospectively reviewed clinical data of children with BS after liver transplantation, with the main focus on diagnostic methods, including imaging studies and histology. All patients underwent endoscopic, transhepatic, or surgical treatment of the stricture.

RESULTS: Sixty-seven patients after LTx performed at the median age of 9.1 years (0.4–18) developed BS, mostly within the first 12 months (40%). Laboratory findings at diagnosis were: bilirubin 4.65 (5.8±SD), GGTP 434 (382.9±SD), and ALT 126.5 (116.8±SD); 16 patients presented with bilirubin level <1 mg% and 4 with GGTP below 100 IU. Ultrasound scan (USS) visualized dilatation of the bile ducts in 53 (79%) patients. Overall sensitivity of hepatobiliary scintigraphy (HBS) was 93%, with dilatation of bile ducts in 69% and impaired excretion in 68% of patients. MRCP showed 100% accuracy in detecting biliary dilatation and a stricture was visualized in 39%. Liver histology was consistent with biliary obstruction in 66%. Treatment of BS was successful in the majority of cases, with 89% graft survival.

CONCLUSIONS: Non-invasive investigations are highly sensitive in post-transplant BS and should play the key role in diagnostic algorithms.

Keywords: Biliary Tract Diseases, Child, Liver Transplantation, Postoperative Complications

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358