The Potential of Radiological Methods in the Diagnosis and Prediction of Biliary Complications after Liver Transplantation

Background. Biliary complications, such as choledochojejunal anastomotic strictures and bilomas, remain among the most common (10–30 %) and serious problems in the postoperative period for liver recipients, significantly affecting graft survival and the outcome of transplantation in general. Timely diagnosis is a key factor for successful treatment; however, there is currently no unified protocol for radiological monitoring of patients.

Objective. To assess the diagnostic and prognostic value of a developed standardized protocol for dynamic MSCT/MRI monitoring for the detection and management of biliary complications in patients after liver transplantation.

Materials and methods. A single-center retrospective cross-sectional study of 67 patients who underwent liver transplantation was conducted. All patients underwent MSCT and MRI/MRCP according to a standardized protocol in the preoperative period and dynamically in the postoperative period (on days 3–7, at 1 and 3 months). Patients were divided into groups: those with developed biliary complications (n = 18) and those without (n = 49).

Results. A standardized protocol for dynamic MSCT/MRI monitoring in the early and late postoperative periods improves the diagnosis of biliary complications after liver transplantation. Early detection of biliary complications enables timely application of minimally invasive treatment methods, leading to successful management in over 64 % of cases and significantly reducing the overall incidence of persistent biliary complications from 44.8 % to 26.9 % (p = 0.026, OR = 2.25; 95 % CI 1.09–4.63). Further studies are needed to validate this method.

Conclusion

1. The etiology of the underlying liver disease is a significant predictor of the risk of developing biliary complications after transplantation. The highest risk is associated with Wilson – Konovalov disease (11,1 % vs 0,0 %, р = 0,017, OR = 4,13; 95 % CI 2,66–6,41) and primary sclerosing cholangitis (16,6 % vs 2,1 %, р = 0,023, OR = 9,86; 95 %CI 1,02–102,42).

2. The standardized protocol of dynamic MSCT/MRI monitoring in the early and late postoperative periods allows for improved diagnosis of biliary complications (anastomosis stenosis, biloma) af­ter liver transplantation. Early detection of biliary complications enables the timely application of minimally invasive treatment methods, resulting in successful resolution in more than 64 % of cases and significantly reducing the overall frequency of persistent biliary complications from 44.8 % to 26.9 %, OR = 2,25; 95 % CI 1,09–4,63). 

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