Percutaneous Transhepatic Cholangiogram Post Transplant?

Hi all. Has anyone who is post-liver transplant with their bile ducts not connected to the common bile duct but to your small bowel using a Rou-N-Y procedure, had to have a PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM? After two recent MRCP’s they are suspecting a recurrence of my PSC liver disease. As they cannot go up through the common bile duct anymore they are going to have to use the PTC procedure through my side. There is a possibility that there is just a narrowing from scar tissue where the bile ducts hook up to my small bowel, but they are leaning more to recurrence of Primary Sclerosing Cholangitis.

I’m wondering how the procedure went for you and what they were able to discover, correct, etc. as a result of the procedure. I am quite concerned as you can imagine but am taking this one day at a time. Thanks.


Hello Mark.
I am way behind your progress thru this disease. But will be hoping and praying for you

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My husband had is transplant a year ago and had the same procedure. How long have you been post transplant? Are you on a lot of Immunosuppressives? Saying a prayer for you.

Nothing to contribute in terms of knowledge or experience but my thoughts are with you.

Thank you for your responses. I do appreciate it. Ermalinda I am 6 years post-transplant. I’ve had two periods in the last 6 months of elevated liver enzymes. The first time 2 weeks of Cipro cleared things up. Now it has occurred again and I’m on Cipro again. The transplant team at Duke met this week to discuss my case. After reviewing all the MRCP’s and the labs they are suspicious of recurrent PSC. This procedure I am to have next week is to confirm that or something else. I’m really praying that it is not a recurrence but a narrowing of the duct where it connects to the small bowel, that they can correct. As far as immunosuppressive, I really am not on too much. They are keeping my Tacrolimus levels around 4.5-5.0 which is just below the normal level. I’m on 2 mg of Prograf twice a day. Thanks again.


Dear Mark
Although PSC recurrence is possible in the first 15 years post- liver transplant but as a surgeon, I think anastomosis site stricture is more probable in your case. So don’t worry

Thank you for that encouraging word Hamid. I assume that would also drive up my LFT’s? Here are my labs from today at least the elevated ones. Thanks

AST 74 (high)
ALT 186 (high)
Bilirubin 1.0 (very thankful this is normal)
Alkaline Phosphatase 493 (very high)
INR 1.1


Had the same procedure as you know Mark; however with a living donor. Will be watching this thread since I’m curious too how they would go about an ERCP with this RouxNy procedure. Hope this works out, sounds stressful.

Mark, I hope it is not r-psc. You’ve been through enough.

Welcome back!

Thanks Jeff. I pray it’s not as well. I am hoping it’s just a narrowing where the bile ducts connect to my small bowel at the Roux-N-Y. I am having some RUQ and lower back pain but thankfully my bilirubin is still staying in normal levels. It’s the other numbers that are off the chart that are very concerning. I’ll give an update later this week. The procedure is on Wedneday. Thanks!