(See also Overview of Vascular Disorders of the Liver Overview of Vascular Disorders of the Liver The liver has a dual blood supply. The portal vein (which is rich in nutrients and relatively high in oxygen) provides two thirds of blood flow to the liver. The hepatic artery (which is oxygen-rich)... read more .)
Etiology of Ischemic Cholangiopathy
Common causes of ischemic cholangiopathy include
Vascular injury during orthotopic liver transplantation or laparoscopic cholecystectomy
Graft-rejection injury
Chemoembolization
Radiation therapy
Thrombosis resulting from hypercoagulability disorders
Bile duct injury (ischemic necrosis) results, causing cholestasis, cholangitis Choledocholithiasis and Cholangitis Choledocholithiasis is the presence of stones in bile ducts; the stones can form in the gallbladder or in the ducts themselves. These stones cause biliary colic, biliary obstruction, gallstone... read more , or biliary strictures (often multiple). Ischemic cholangiopathy most commonly occurs in people who have had a liver transplant Liver Transplantation Liver transplantation is the 2nd most common type of solid organ transplantation. (See also Overview of Transplantation.) Indications for liver transplantation include Cirrhosis (70% of transplantations... read more .
Symptoms and Signs of Ischemic Cholangiopathy
Symptoms (eg, pruritus, dark urine, pale stools) and results of laboratory tests and imaging studies may indicate cholestasis.
Diagnosis of Ischemic Cholangiopathy
Magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography (ERCP), or both
The diagnosis is suspected when cholestasis is evident in patients at risk, particularly after liver transplantation Liver Transplantation Liver transplantation is the 2nd most common type of solid organ transplantation. (See also Overview of Transplantation.) Indications for liver transplantation include Cirrhosis (70% of transplantations... read more . Ultrasonography is the first-line diagnostic imaging test for cholestasis, but most patients require magnetic resonance cholangiopancreatography, ERCP, or both to rule out other causes such as cholelithiasis Cholelithiasis Cholelithiasis is the presence of one or more calculi (gallstones) in the gallbladder. Gallstones tend to be asymptomatic. The most common symptom is biliary colic; gallstones do not cause dyspepsia... read more 
or cholangiocarcinoma (see Imaging Tests of the Liver and Gallbladder Imaging Tests of the Liver and Gallbladder Imaging is essential for accurately diagnosing biliary tract disorders and is important for detecting focal liver lesions (eg, abscess, tumor). It is limited in detecting and diagnosing diffuse... read more ).
Treatment of Ischemic Cholangiopathy
For rejection, antirejection therapy and possibly retransplantation
For biliary strictures, balloon dilation and stenting
Treatment is directed at the cause. After liver transplantation Liver Transplantation Liver transplantation is the 2nd most common type of solid organ transplantation. (See also Overview of Transplantation.) Indications for liver transplantation include Cirrhosis (70% of transplantations... read more , such treatment includes antirejection therapy and possible retransplantation. Biliary strictures warrant endoscopic balloon dilation and stenting.
