title: Obstructive dilatation of extrahepatic recipient and donor bile ducts complicating orthotopic liver transplantation: imaging and laboratory findings.
abstract: Biliary obstruction in liver transplants is most commonly due to stricture at the biliary anastomosis. The native common bile duct typically is normal. We retrospectively studied 28 patients with choledochocholedochostomy anastomoses who had marked native and donor extrahepatic bile duct dilatation associated with clinical evidence of biliary obstruction. Operative cholangiograms were compared with postoperative cholangiograms obtained a mean of 50 weeks (range, 2-246 weeks) later. Mean caliber of the native common bile duct increased from 7.5 +/- 2.0 mm on operative cholangiograms to 14.8 +/- 3.9 mm on postoperative cholangiograms (p less than .001). Mean caliber of the donor common hepatic duct increased from 5.9 +/- 1.3 mm on operative cholangiograms to 12.8 +/- 3.8 mm on postoperative cholangiograms (p less than .001). Dilatation of the cystic duct remnant was seen in 15 patients. All patients had surgical revision to choledochojejunostomy with improved results of liver function studies in most cases. Diffuse dilatation of native and donor extrahepatic bile ducts may develop in liver transplant recipients. Typical features include native and donor extrahepatic ducts greater than 12 mm in diameter and a dilated cystic duct remnant on postoperative cholangiography in a patient with otherwise unexplained hepatic dysfunction.
authors.affiliation: Department of Radiology, University of Pittsburgh School of Medicine, Presbyterian University Hospital, PA 15213.
authors.forename: W J
authors.initials: WJ
authors.lastname: Miller
authors.forename: W L
authors.initials: WL
authors.lastname: Campbell
authors.forename: A B
authors.initials: AB
authors.lastname: Zajko
authors.forename: A
authors.initials: A
authors.lastname: Pinna
authors.forename: G
authors.initials: G
authors.lastname: Zetti
authors.forename: A C
authors.initials: AC
authors.lastname: Stieber
authors.forename: R G
authors.initials: RG
authors.lastname: Foster
authors.forename: J W
authors.initials: JW
authors.lastname: Lecky
authors.forename: K Y
authors.initials: KY
authors.lastname: Lee
mesh_terms: D000328:Adult; D001652:Bile Ducts / Q000473:pathology; D002758:Cholangiography; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology; D003135:Common Bile Duct / Q000000981:diagnostic imaging; D003549:Cystic Duct / Q000000981:diagnostic imaging; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012086:Reoperation