title: Percutaneous transhepatic cholangiography and drainage is an effective rescue therapy for biliary complications in liver transplant recipients who fail endoscopic retrograde cholangiopancreatography.
abstract: BACKGROUND
  We attempted to evaluate both the factors that predispose a patient to biliary complications after liver transplantation and the results of percutaneous transhepatic cholangiography and drainage (PTCD) for the management of those complications.
  
  
  METHODS
  This study retrospectively reviewed the cases of 81 patients who received liver transplants at Taipei Veterans General Hospital between February 2003 and June 2008. Biliary complications were diagnosed on the basis of clinical findings, laboratory data, and the results of imaging studies.
  
  
  RESULTS
  A total of 18 patients (22.2%) developed biliary complications, and living donor liver transplantation (LDLT) was a significant risk factor (p = 0.035), compared to cadaveric liver transplantation. Eight patients with biliary complications received PTCD as the first treatment modality and 6 had successful results. An additional 10 patients received endoscopic retrograde cholangiopancreatography (ERCP) initially, but only 2 patients were effectively managed. One patient received conservative treatment after ERCP failure. One patient died from sepsis after ERCP. The remaining 6 patients with failed ERCP were successfully managed with PTCD. The overall mortality rate in these patients with biliary complications was 16.7%. No significant prognostic predictors were identified, including age, sex, biochemical data, and model for end-stage liver disease scores.
  
  
  CONCLUSIONS
  Biochemical markers cannot predict biliary complications preoperatively. LDLT increases the risk of biliary complications. PTCD is an effective rescue therapy when ERCP fails.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
authors.forename: Hung-Hsu
authors.initials: HH
authors.lastname: Hung
authors.forename: Tseng-Shing
authors.initials: TS
authors.lastname: Chen
authors.forename: Hsiuo-Shan
authors.initials: HS
authors.lastname: Tseng
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.forename: Chin-Su
authors.initials: CS
authors.lastname: Liu
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Che-Chuan
authors.initials: CC
authors.lastname: Loong
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000628:therapy*; D002758:Cholangiography / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies