title: Risk factors of biliary intervention by imaging after living donor liver transplantation.
abstract: OBJECTIVE
  To determine the risk factors of biliary intervention using magnetic resonance cholangiopancreatography (MRCP) after living donor liver transplantation (LDLT).
  
  
  METHODS
  We retrospectively enrolled 196 patients who underwent right lobe LDLT between 2006 and 2010 at a single liver transplantation center. Direct duct-to-duct biliary anastomosis was performed in all 196 patients. MRCP images routinely taken 1 mo after LDLT were analyzed to identify risk factors for biliary intervention during follow-up, such as retrograde cholangiopancreatography or percutaneous transhepatic biliary drainage. Two experienced radiologists evaluated the MRCP findings, including the anastomosis site angle on three-dimensional images, the length of the filling defect on maximum intensity projection, bile duct dilatation, biliary stricture, and leakage.
  
  
  RESULTS
  Eighty-nine patients underwent biliary intervention during follow-up. The anastomosis site angle [hazard ratio (HR) = 0.48; 95% confidence interval (CI), 0.30-0.75, P < 0.001], a filling defect in the anastomosis site (HR = 2.18, 95%CI: 1.41-3.38, P = 0.001), and biliary leakage (HR = 2.52, 95%CI: 1.02-6.20, P = 0.048) on MRCP were identified in the multivariate analysis as significant risk factors for biliary intervention during follow-up. Moreover, a narrower anastomosis site angle (i.e., below the median angle of 113.3°) was associated with earlier biliary intervention (38.5 ± 4.2 mo vs 62. 1 ± 4.1 mo, P < 0.001). Kaplan-Meier analysis comparing biliary intervention-free survival according to the anastomosis site angle revealed that lower survival was associated with a narrower anastomosis site angle (36.3% vs 62.0%, P < 0.001).
  
  
  CONCLUSIONS
  The biliary anastomosis site angle in MRCP after LDLT may be associated with the need for biliary intervention.
authors.affiliation: Soon Kyu Lee, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
authors.forename: Soon Kyu
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Soon Kyu Lee, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Soon Kyu Lee, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
authors.forename: Dong Myung
authors.initials: DM
authors.lastname: Yeo
authors.affiliation: Soon Kyu Lee, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Soon Kyu Lee, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
authors.affiliation: Soon Kyu Lee, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.affiliation: Soon Kyu Lee, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
authors.affiliation: Soon Kyu Lee, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
authors.forename: Hee Yeon
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Soon Kyu Lee, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
authors.forename: Dong Goo
authors.initials: DG
authors.lastname: Kim
authors.affiliation: Soon Kyu Lee, Jong Young Choi, Seung Kew Yoon, Si Hyun Bae, Jeong Won Jang, Hee Yeon Kim, Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
authors.forename: Young Kyoung
authors.initials: YK
authors.lastname: You
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D018572:Disease-Free Survival; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Biliary intervention; Endoscopic retrograde cholangiopancreatography; Liver transplantation; Living donor; Magnetic resonance cholangiopancreatography; Percutaneous transhepatic biliary drainage