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Biliary complications after orthotopic liver transplantation: MRCP findings

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Abstract

Orthotopic liver transplantation is a widely accepted treatment for end-stage liver disease and selected cases of hepatocellular carcinoma. Despite surgical progresses, biliary complications after transplantation remain a serious cause of morbidity, mortality, and graft dysfunction or failure in recipients. Early complications occur within a few weeks after transplantation and are mainly represented by bile leakage. Late complications, which become evident from 3 months to years, include strictures, stones, intraductal debris or sludge formation, kinking and ampullary dysfunction. Donor-to-recipient common bile duct disproportion has been reported as a borderline condition. Diagnosis is challenging because of the low specificity of clinical and biologic findings. Sonography does not provide projectional images of the biliary tract or direct evaluation of the anastomoses. Moreover, direct cholangiographic procedures have an unacceptable rate of complications to be used in patients with low clinical suspicion. Magnetic resonance cholangiography is a safe and accurate tool, playing an increasing role in the diagnosis and management of biliary complications. Heavily T2-weighted images provide panoramic, detailed evaluation of the biliary tract, showing biliary complications as a variable combination of bile duct dilatation, strictures, filling defects, fluid collections and peculiar morphologic changes, as described in this paper.

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Acknowledgments

The authors wish to thank Dr. Anna Linda for precious collaboration in reviewing the manuscript, and Mr. Michele Basso for the drawings.

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Authors and Affiliations

  1. Department of Medical and Morphological Research, Institute of Radiology, University of Udine, via Colugna 50, Udine, 33100, Italy

    Rossano Girometti, Lorenzo Cereser, Giuseppe Como, Chiara Zuiani & Massimo Bazzocchi

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  1. Rossano Girometti
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Correspondence to Rossano Girometti.

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Girometti, R., Cereser, L., Como, G. et al. Biliary complications after orthotopic liver transplantation: MRCP findings. Abdom Imaging 33, 542–554 (2008). https://doi.org/10.1007/s00261-007-9316-z

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