Percutaneous transhepatic cholangiography rather than ultrasound as a screening test for postoperative biliary complications in liver transplant patients.

DIAGNOSTIC IMAGING of the biliary tract is often required in liver transplant patients with suspected biliary com plications.u Direct cholangiography. either percutaneous transhepatic (PTC) or endoscopic retrograde. is the definitive radiological examination for the detection of biliary abnormalities.) Ultrasound (US) is noninvasive and accurate in detecting dilatation of the biliary tree. On the basis of experience in non transplant patients. US has traditionally been considered the screening examination of choice for detecting bile duct obstruction.4•5 Because liver allograft recipients undergo close postoperative laboratory monitoring, elevation of liver enzyme levels is often the first manifestation of a biliary complication. Because transplant patients typically undergo imaging evaluation early and because certain allograft biliary complications are not necessarily accompanied by ductal enlargement, bile duct dilatation is often not seen. In this study, we review the results of US examinations performed in 50 transplant patients with biliary complications diagnosed by PTe. Data are presented that show that US is insensitive as a screening test in the early detection of biliary complications in liver allograft recipients.