title: [A case of biliary cast syndrome after cadaveric liver transplantation].
abstract: We experienced one fatal case of biliary cast syndrome after cadaveric liver transplantation involving both intrahepatic ducts. A 58-year-old man underwent cadaveric liver transplantation because of hepatitis B virus related liver cirrhosis and concomitant hepatocellular carcinoma. Five weeks after the liver transplantation, postoperative course was complicated by development of acute cholangitis. Subsequent endoscopic retrograde cholangiography revealed diffuse intrahepatic bile duct strictures without filling defects. Percutaneous liver biopsy, which was done to exclude rejection, revealed biliary cast. Successful endoscopic removal was precluded due to its diffuse involvement. Because of the deterioration of patient's condition by refractory biliary obstruction and cholangitis, retransplantation from cadaveric donor was performed. Debridement of the biliary tree after graft removal yielded a near-complete cast of the intrahepatic ductal system. Biliary cast syndrome should be suspected when jaundice or cholangitis is associated with dilated ducts on abdominal imaging studies in cadaveric liver transplantation recipients. Initial therapeutic options include removal of biliary cast after endoscopic or percutaneous cholangiography. Although endoscopic retrieval of biliary cast by endoscopic retrograde cholangiopancreatography could be employed as a first-line management, other modalities such as endoscopic nasobiliary drainage, percutaneous transhepatic drainage, or retransplantation should be considered when complete removal is not feasible and the condition of the recipient deteriorates.
authors.affiliation: Department of Internal Medicine, Catholic University of Daegu School of Medicine, Nam-Gu, Daegu, Korea.
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Seo
authors.forename: Jin Tae
authors.initials: JT
authors.lastname: Jung
authors.forename: Jimin
authors.initials: J
authors.lastname: Han
authors.forename: Ho Gak
authors.initials: HG
authors.lastname: Kim
authors.forename: Joo Hyoung
authors.initials: JH
authors.lastname: Lee
authors.forename: Sang Hun
authors.initials: SH
authors.lastname: Sung
authors.forename: Woo Young
authors.initials: WY
authors.lastname: Choi
authors.forename: Dong Lark
authors.initials: DL
authors.lastname: Choi
mesh_terms: D001649:Bile Duct Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D017734:Bile Ducts, Extrahepatic / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017809:Fatal Outcome; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed