A Case of Biliary Cast Syndrome after Cadaveric Liver Transplantation.
- Author:
Chang Jin SEO
1
;
Jin Tae JUNG
;
Jimin HAN
;
Ho Gak KIM
;
Joo Hyoung LEE
;
Sang Hun SUNG
;
Woo Young CHOI
;
Dong Lark CHOI
Author Information
1. Departments of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. jungjt@cu.ac.kr
- Publication Type:Case Report ; English Abstract
- Keywords:
Biliary cast syndrome;
Biliary stricture;
Cadaveric liver transplantation
- MeSH:
Bile Duct Diseases/*diagnosis/etiology/pathology;
Bile Ducts, Extrahepatic/pathology;
Bile Ducts, Intrahepatic/pathology;
Cholangiopancreatography, Endoscopic Retrograde;
Fatal Outcome;
Humans;
Jaundice, Obstructive/etiology;
*Liver Transplantation;
Male;
Middle Aged;
Postoperative Complications/*diagnosis/pathology/radiography;
Tomography, X-Ray Computed
- From:The Korean Journal of Gastroenterology
2007;49(2):106-109
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
We experienced one fatal case of biliary cast syndrome after cadaveric liver transplantation involving both intrahepatic ducts. A 58-year-old man underwent cadaveric liver transplantation because of hepatitis B virus related liver cirrhosis and concomitant hepatocellular carcinoma. Five weeks after the liver transplantation, postoperative course was complicated by development of acute cholangitis. Subsequent endoscopic retrograde cholangiography revealed diffuse intrahepatic bile duct strictures without filling defects. Percutaneous liver biopsy, which was done to exclude rejection, revealed biliary cast. Successful endoscopic removal was precluded due to its diffuse involvement. Because of the deterioration of patient's condition by refractory biliary obstruction and cholangitis, retransplantation from cadaveric donor was performed. Debridement of the biliary tree after graft removal yielded a near-complete cast of the intrahepatic ductal system. Biliary cast syndrome should be suspected when jaundice or cholangitis is associated with dilated ducts on abdominal imaging studies in cadaveric liver transplantation recipients. Initial therapeutic options include removal of biliary cast after endoscopic or percutaneous cholangiography. Although endoscopic retrieval of biliary cast by endoscopic retrograde cholangiopancreatography could be employed as a first-line management, other modalities such as endoscopic nasobiliary drainage, percutaneous transhepatic drainage, or retransplantation should be considered when complete removal is not feasible and the condition of the recipient deteriorates.
