title: Pathotyping and clinical manifestations of biliary cast syndrome in patients after an orthotopic liver transplant.
abstract: OBJECTIVE
  To summarize the pathotyping and clinical manifestations of biliary cast syndrome in patients after an orthotopic liver transplant.
  
  
  METHODS
  The clinical manifestations, auxiliary examination, therapeutic regimen, and clinical efficacy of 103 biliary cast syndrome patients who underwent an orthotopic liver transplant were retrospectively analyzed. Patients were divided into 6 groups from type 1 to type 6, according to the injury level of the biliary duct epithelium.
  
  
  RESULTS
  Many biliary cast syndrome patients showed symptoms including jaundice, dark urine, argillaceous stool, itchy skin, and fever. Serum levels of alanine aminotransferase, γ-glutamyl transpeptidase, alkaline phosphatase, and total bilirubin were increased. In addition, total white cell counts in peripheral blood also were increased. T-tube cholangiography showed filling defects of various amounts. Optical fiber choledochoscope examination revealed that the biliary tract was filled with solid substances, and necrosis of the biliary tract epithelium was observed in some biliary cast syndrome patients. From type 1 to type 6 biliary cast syndrome patients, the probability of clinical symptoms and biliary tract stricture gradually increased, the time needed for supporting gradually prolonged after removal of the biliary cast, and T-tube cholangiography showed that the filling defects gradually expanded.
  
  
  CONCLUSIONS
  Clinical manifestations and cholangiography presentations mainly depend on pathotyping.
authors.affiliation: From the Liver Transplantation Institute of Armed Police Force, General Hospital of Chinese Armed Police Force, Beijing 100039, China. xiaodan-zhu@hotmail.com
authors.forename: Xiao-dan
authors.initials: XD
authors.lastname: Zhu
authors.forename: Zhong-yang
authors.initials: ZY
authors.lastname: Shen
authors.forename: Xin-guo
authors.initials: XG
authors.lastname: Chen
authors.forename: Yun-jin
authors.initials: YJ
authors.lastname: Zang
mesh_terms: D000328:Adult; D000368:Aged; D001659:Biliary Tract / Q000000981:diagnostic imaging / Q000473:pathology; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D002758:Cholangiography / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging / Q000473:pathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult