BioScience Trends. 2007;1(1):62-65.
Role of protocol ultrasonography for detecting biliary stricture in adult living donor liver transplantation recipients.
Que YH, Kaneko J, Sugawara Y, Tamura S, Makuuchi M
The role of protocol ultrasonography (US) in detecting biliary stricture (BS) after adult living donor liver transplantation (ALDLT) remains to be clarified. We reviewed 268 ALDLT cases with BS to assess the role of protocol US. The sensitivity and specificity of serum values of gamma-glutamyl transpeptidase (G-GTP) and alkaline phosphatase (ALP) as indicators of BS were evaluated and compared with the US findings. Diagnosis of BS was made by dripinfusion cholangiography or direct endoscopic retrograde cholangiography. Fifty patients (19%) developed BS; anastomotic stricture in 46 and non-anastomotic in 4. The incidence of BS was not affected by the method of bile duct reconstruction or the type of graft. Protocol US detected dilated bile ducts (≥ 3 mm) in 45 cases (90%) with BS. The mean diameter of bile ducts in the BS group was 5 ± 2 mm, which was greater than that of patients without BS (2 ± 1 mm, P < 0.001). When the bile duct diameter was over 3 mm, the sensitivity and specificity of protocol US for the diagnosis of BS was 96% and 91%, respectively, whereas those of G-GTP were 60% and 74% when the values were more than 5-fold greater than the upper normal limit, and those of ALP were 56% and 62% when the values were 3-fold greater than the upper normal limit. The bile duct diameter and the G-GTP and ALP values did not correlate. US might be a useful and efficient imaging method to follow-up patients after ALDLT.