Biliary complications after liver transplantation

Abstract

Biliary complications are considered the Achilles’ heel of orthotopic liver transplantation and significantly influence the outcome of the patient. Ischemia, rejection of the donor tissue, and recurring underlying disease contribute to the etiology of biliary complications. Biliary strictures constitute 40-60% of biliary complications after liver transplantation. They are more common after living donor-related liver transplantation (LDLT) than orthotopic liver transplantation (OLT). Thereby, anastomotic biliary stricture (ABS) needs differentiation from non-anastomotic stricture (NAS), such as ischemic-type biliary lesions (ITBL) that occur within the intrahepatic and proximal bile ducts. Multiple plastic stent insertion, in some centers following hydrostatic balloon dilation, will achieve stricture resolution in a high rate of over 80% of choledocho-choledochal ABS in OLT patients. Success rate of endoscopic treatment of ABSs after LDLT may be less successful because of the small size of the ABSs, their multiple number, and peripheral localization. Balloon dilation followed by multiple plastic stent insertion may achieve a mean resolution rate of about 50%. Percutaneous transhepatic biliary drainage is rarely required in complex cases when endoscopic therapy failed.