Is MRCP equivalent to ERCP for diagnosing biliary obstruction in orthotopic liver transplant recipients? A meta-analysis

BackgroundBiliary complications are the second leading cause of morbidity and mortality in orthotopic liver transplant (OLT) recipients. Endoscopic retrograde cholangiography (ERC) is considered the diagnostic criterion standard for post-orthotopic liver transplantation biliary obstruction, but incurs significant risks.ObjectiveTo determine the diagnostic accuracy of MRCP for biliary obstruction in OLT patients.DesignA systematic literature search identified studies primarily examining the utility of MRCP in detecting post-orthotopic liver transplantation biliary obstruction. A meta-analysis was then performed according to the Quality of Reporting Meta-Analyses statement.SettingMeta-analysis of 9 studies originally performed at major transplantation centers.PatientsA total of 382 OLT patients with clinical suspicion of biliary obstruction.InterventionsMRCP and ERCP or clinical follow-up.Main Outcome MeasurementsSensitivity and specificity of MRCP for diagnosis of biliary obstruction.ResultsThe composite sensitivity and specificity were 0.96 (95% CI, 0.92-0.98) and 0.94 (95% CI, 0.90-0.97), respectively. The positive and negative likelihood ratios were 17 (95% CI, 9.4-29.6) and 0.04 (95% CI, 0.02-0.08), respectively.LimitationsAll but 1 included study had significant design flaws that may have falsely increased the reported diagnostic accuracy.ConclusionsThe high sensitivity and specificity demonstrated in this meta-analysis suggest that MRCP is a promising test for diagnosing biliary obstruction in patients who have undergone liver transplantation. However, given the significant design flaws in most of the component studies, additional high-quality data are necessary before unequivocally recommending MRCP in this setting.