Objective   To investigate the ultrasonograms of biliary sludge and its relationship with the prognosis of patients after liver transplantation.

  Methods   Ultrasonograms of 36 patients with biliary sludge after liver transplantation were retrospectively analyzed. These patients were divided into two groups according to the different treatment outcomes: poor prognosis group and favorable prognosis group. The characteristics of initial ultrasonograms of biliary sludge when they were found at first time compared between two groups.

  Results  Biliary sludge combined with ischemic-type biliary lesions accounted for 95%(19/20) in poor prognosis group while 13%(2/16) in favorable prognosis group. There was significant difference between two groups(P < 0.05). In favorable prognosis group, biliary sludge was found locating in hepatic hilar region in all 16 cases (16/16) and the sludge had clear boundaries dissociated with bile duct walls were observed in 14 cases (14/16). There was no incrassation of bile duct walls in hepatic hilar region, nor dilation of intrahepatic bile ducts observed in 14 cases (14/16). In poor prognosis group, biliary sludge was observed widespread not only in hepatic hilar region but also in intrahepatic biliary ducts in 10 cases (10/20), and the boundaries between sludge and bile duct walls were vague in 15 cases (15/20). Obvious incrassation of bile duct walls in hepatic hilar region was observed in 16 cases (16/20), and dilation of intrahepatic bile ducts was observed in 19 cases (19/20). There were significant differences in the above 4 ultrasound features between two groups (all in P < 0.05).

  Conclusions   There are differences in the ultrasonograms of biliary sludge between different prognosis groups. Biliary sludge combined with ischemic-type biliary lesions suggests a poor prognosis, which may need more active interventional treatments.