Methylene blue-aided cholangioscopy unravels the endoscopic features of ischemic-type biliary lesions after liver transplantation.

摘要

Since the advent of transplantation as a life-saving procedure for patients with end-stage liver disease, more than 15,000 people have undergone orthotopic liver transplantation (OLT). However, various biliary complications may occur on transplantation, and asymptomatic elevation of liver enzymes is frequently the first sign of biliary complications after OLT. Ischemic-type biliary lesions (ITBLs) are the most frequent cause of nonanastomotic biliary strictures in liver grafts, affecting about 2% to 19% of patients after liver transplantation. ITBLs are defined as nonimmunologic destruction of the graft's biliary tree after OLT and are characterized by bile duct destruction, subsequent stricture formation, and sequestration. Their histopathologic appearance suggests that microcirculatory problems resulting from ischemic reperfusion may play a role in their development, but the exact pathogenesis of ITBLs is still poorly understood.