Biliary cast syndrome after liver transplantation: A cholangiographic evolution study

Area of Science:

• Hepatobiliary Surgery
• Transplant Surgery
• Gastroenterology

Background:

• Biliary cast syndrome (BCS) is a rare ischemic cholangiopathy following liver transplantation.
• Understanding its cholangiographic features and endoscopic management is crucial.

Purpose of the Study:

• To describe the cholangiographic features of BCS.
• To detail the endoscopic management of BCS.
• To evaluate outcomes of BCS following liver transplantation.

Main Methods:

• Retrospective review of 311 liver transplant patients from January 2005 to December 2014.
• Identification and analysis of 14 BCS cases.
• Systematic review of cholangiograms from ERCP and MRI, alongside clinical and endoscopic data.

Main Results:

• BCS identified in 4.5% of liver transplant recipients.
• Characteristic MRI findings include intraductal hyperintense T1 signal and "duct-in-a-duct" appearance.
• Complete cast extraction achieved in 85.7% of cases, with high rates of secondary biliary strictures (85%) and lower long-term survival (42.9%).

Conclusions:

• Specific cholangiographic features on MRI and ERCP aid in BCS diagnosis.
• BCS management involves high rates of cast extraction but is associated with frequent secondary strictures and poorer prognosis compared to other biliary complications.