Ischemic-Type Biliary Lesions Without Hepatic Artery Occlusion After Liver Transplantation: Early Diagnosis Of Cholangiography And Interventional Radiology Treatment

With the improvement of preservation and surgical techniques,morbidity andmortality of biliary tract complication after liver transplantation was reducedobviously, but still as high as 8%～25% and 1%～5%,respectively. Ischemic-type biliarylesions(ITBL) are considered to be the most troublesome biliary complication,socalled "The Achilles Heel Revisited".The purpose of our study are evaluated the valueof early diagnosis of cholangiography and the efficacy of interventional radiologytreatment for ITBL after liver transplantation.This study included two parts.In the first part,253 patients who underwent livertransplantaion between Jan 2004 and Oct 2006 were studied.Initial cholangiographywas compared with terminal cholangiography, to evaluated the value of Initialcholangiograph of ITBL,and statistical analyses of the clinical variables were donesimultaneity.Results: the abnormal initial cholangiography was associated with ITBLsignificantly (x~2=79.999, P=0.000) .Initial cholangiography had an overallsensitivity of 72.22%,and specificity of 87.44%,with positive and negative predictivevalues of 60.94% and 92.06% respectively. The abnormal Initial cholangiographywere risk factor of ITBL by logistic regression analyses.In the second part, 55 ITBL patients who had the T-tube approachinterventional radiology treatment between Jan 2004 and Oct 2006 were studied.Thepurpose to evaluated efficacy and clinical variables of the T-tube approachinterventional radiology treatment. Results:53 patients had successfully treatment.21 patients (39.62%) were recovery and tube independent, 20 patients (37.74%) were ineffect,but tube can not be removed. 12 patients (22.64%) were no effect,3 patientswere died,9 patients were retransplantation.There are no recurrent in 21 tubeindependent patients. Only 1 patient(1/53, 1.89%) ) has complications.There aresignificant associations between efficacy and the type of ITBL cholangiography (x~2=29.055, P=0.000).Conclusion:1. The abnormal initial cholangiography was associated with ITBLsignificantly.Initial cholangiography, epecially minimal irregular of intrahepatic biliarytract, is a sensitive and specific method for the detection of ITBL after livertransplantation.2. The T-tube approach interventional radiology treatment should be adoptedfirst.The sluge/stone should be treatment first. The balloon dilatation and large profilecatheter maintennace method is an effective therapeutic alternative for the ITBL afterliver transplantation.3. There are significant associations between efficacy and the type of ITBLcholangiographyo The prognosis of diffuse type ITBL were worse.