title: Biliary Cast Syndrome: Hepatic Artery Resistance Index, Pathological Changes, Morphology and Endoscopic Therapy.
abstract: BACKGROUND
  Biliary cast syndrome (BCS) was a postoperative complication of orthotopic liver transplantation (OLT), and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index (HARI), and to observe pathological changes and morphology of biliary casts.
  
  
  METHODS
  Totally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks 1, 2, 3 shown by color Doppler flow imaging. The compositions of biliary casts were analyzed by pathological examination and scanning electron microscopy.
  
  
  RESULTS
  HARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 (P < 0.05). Odds ratio (OR) analysis of HARI 1, HARI 2, HARI 3 following the operation was >1 (OR = 1.300; 1.223; and 1.889, respectively). The OR of HARI 3 was statistically significant (OR = 1.889; 95% confidence interval = 1.166-7.490; P = 0.024). The compositions of biliary casts were different when bile duct stones were present. Furthermore, vascular epithelial cells were found by pathological examination in biliary casts.
  
  
  CONCLUSIONS
  HARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of biliary casts and bile duct stones are different.
authors.forename: Hu
authors.initials: H
authors.lastname: Tian
authors.affiliation: Hepatobiliary and Enteric Surgery Research Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
authors.forename: Qian-De
authors.initials: QD
authors.lastname: Liao
authors.forename: Nian-Feng
authors.initials: NF
authors.lastname: Li
authors.forename: Jian
authors.initials: J
authors.lastname: Peng
authors.forename: Lian-Sheng
authors.initials: LS
authors.lastname: Gong
authors.forename: Ju
authors.initials: J
authors.lastname: Liu
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D005260:Female; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged