title: Co-occurrence of nonanastomotic biliary stricture and acute cellular rejection in liver transplant.
abstract: BACKGROUND
  Nonanastomotic biliary stricture is generally considered the most troublesome biliary complication after liver transplant. Nonanastomotic biliary stricture owing to immunologic cholangiopathy (such as acute cellular rejection) has not been reported. We describe 2 patients with the co-occurrence of nonanastomotic biliary stricture and acute cellular rejection after pediatric live-donor liver transplant. CASE 1: A 13-month-old male infant with liver cirrhosis underwent an ABO-identical live-donor liver transplant using a left lateral segment graft. Eighty days after the live-donor liver transplant, ever with liver dysfunction and dilatation of the intrahepatic bile duct occurred. Percutaneous transhepatic biliary drainage and a liver biopsy were performed. The histopathologic evaluation indicated the presence of acute cellular rejection. After percutaneous transhepatic biliary drainage and steroid pulse treatment, the patient showed good clinical outcome. CASE 2: A 21-month-old female infant with biliary atresia underwent an ABO-identical live-donor liver transplant using a left lateral segment graft. Twenty-six days after the live-donor liver transplant, percutaneous transhepatic biliary drainage for B3 and a liver biopsy were performed, owing to fever, with liver dysfunction, and dilatation of the intrahepatic bile duct. Histopathologic evaluation indicated the presence of acute cellular rejection. After percutaneous transhepatic biliary drainage and steroid pulse treatment, the patient showed good clinical outcome.
  
  
  CONCLUSIONS
  It is important for patients with nonanastomotic biliary stricture to undergo early liver biopsy because the nonanastomotic biliary stricture may be coincident with, or caused by, acute cellular rejection.
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, Yakushiji, Shimotsuke City, Japan. yuki371@jichi.ac.jp
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Sanada
authors.forename: Koichi
authors.initials: K
authors.lastname: Mizuta
authors.forename: Taizen
authors.initials: T
authors.lastname: Urahashi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ihara
authors.forename: Taiichi
authors.initials: T
authors.lastname: Wakiya
authors.forename: Noriki
authors.initials: N
authors.lastname: Okada
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Egami
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
authors.forename: Hideo
authors.initials: H
authors.lastname: Kawarasaki
mesh_terms: D000208:Acute Disease; D000714:Anastomosis, Surgical; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D001660:Biliary Tract Diseases / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D004322:Drainage / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology; D013256:Steroids / Q000008:administration & dosage*
chemical_list: D013256:Steroids