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Endoscopic retrograde cholangiopancreatography and liver biopsy in the evaluation of elevated liver function tests after liver transplantation

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World Journal of Hepatology 2021年第1期13卷 132-143页

作者： Augustin Attwell Samuel Han Michael Kriss Department of Medicine University of Colorado-DenverDenverCO 80203United States Department of Medicine Ohio State University Wexler Medical SchoolColumbusOH 43210United States Department of Medicine University of Colorado Medical SchoolAuroraCO 80045United States

BACKGROUND Abnormal liver function tests(LFTs)in post-liver transplant(LT)patients pose a challenge in the timing and selection of diagnostic *** are little data regarding the accuracy of endoscopic retrograde cholangiopancreatography(ERCP)and liver biopsy(LB)in diagnosing post-transplant *** To evaluate the diagnostic performance of ERCP and LB in patients with nonvascular post-LT *** This single-center retrospective study evaluated patients undergoing both ERCP and LB for evaluation of elevated LFTs within 6 mo of LT from 2000 to *** operating characteristics including accuracy,sensitivity and specificity for various diagnoses were calculated for ERCP and *** R factor(ratio of alkaline phosphatase to alanine aminotransferase)was also calculated for each *** Of the 1284 patients who underwent LT,91 patients(74.7%males,mean age of 51)were *** strictures(AS,24.2%),acute cellular rejection(ACR,11%)and concurrent AS/ACR(14.3%)were the most common *** carried an accuracy of 79.1%(95%CI:69.3-86.9),LB had an accuracy of 93.4%(95%CI:86.2-97.5),and the combination of the two had an accuracy of 100%(95%CI:96-100).There was no difference between patients with AS and ACR in mean R factor(AS:1.9 vs ACR:1.1,P=0.24).Adverse events did not differ between the two tests(ERCP:3.1%vs LB:1.1%,P=0.31).CONCLUSION In patients with abnormal LFTs after LT without vascular complications,the combination of LB and ERCP carries low risk and improves diagnostic accuracy over either test alone.

关键词： Liver transplantation Endoscopic retrograde cholangiopancreatography Liver biopsy Abnormal liver tests Acute cellular rejection anastomotic biliary stricture

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