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Journal of Clinical and Experimental Hepatology logoLink to Journal of Clinical and Experimental Hepatology
. 2012 Apr 12;2(1):81–85. doi: 10.1016/S0973-6883(12)60085-1

Post-liver Transplant Biliary Complications

Tegpal Atwal 1, Mariel Pastrana 1, Bimaljit Sandhu 1,*
PMCID: PMC3940277  PMID: 25755409

Abstract

Biliary tract complications remain a common source of morbidity and mortality in liver transplant (LT) recipients with an estimated incidence of 5–30% after orthotopic LT and a mortality rate of up to 10%. Biliary complications after LT may be related to various factors including hepatic artery thrombosis or stenosis, ischemia reperfusion injury, immunologic injury, infections, donor pool, and technical issues which include imperfect anastomosis and T-tube-related complications. Management of the detected biliary complications includes nonsurgical and surgical methods. A majority of these post transplant biliary complications can be treated with endoscopic retrograde cholangiography. If unsuccessful, a percutaneous intervention or surgery may be required. In this article, we review the incidence, clinical presentation, and management of the main types of biliary complications.

Keywords: Anastomotic strictures, bile duct stricture, bile leak, biliary complications, non-anastomotic strictures, orthotopic liver transplantation

Abbreviations: AS, anastomotic strictures; ERCP, endoscopic retrograde cholangiopancreatography; MRCP, magnetic resonance cholangiopancreatography; NAS, non-anastomotic strictures; PTC, percutaneous transhepatic cholangiography; SOD, sphincter of Oddi dysfunction

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References

  • 1.Greif F, Bronsther OL, Van Thiel DH. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg. 1994;219:40–45. doi: 10.1097/00000658-199401000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Wojcicki M, Milkiewicz P, Silva M. Biliary tract complications after liver transplantation: a review. Dig Surg. 2008;25:245–257. doi: 10.1159/000144653. [DOI] [PubMed] [Google Scholar]
  • 3.Moser MA, Wall WJ. Management of biliary problems after liver transplantation. Liver Trans. 2001;7:S46–S52. doi: 10.1053/jlts.2001.28518. [DOI] [PubMed] [Google Scholar]
  • 4.Todo S, Furukawa H, Kamiyama T. How to prevent and manage biliary complications in living donor liver transplantation? J Hepatol. 2005;43:22–27. doi: 10.1016/j.jhep.2005.05.004. [DOI] [PubMed] [Google Scholar]
  • 5.O'Connor TP, Lewis WD, Jenkins RL. Biliary tract complications after liver transplantation. Arch Surg. 1995;130:312–317. doi: 10.1001/archsurg.1995.01430030082017. [DOI] [PubMed] [Google Scholar]
  • 6.Thuluvath PJ, Pfau PR, Kimmey MB, Ginsberg GG. Biliary complications after liver transplantation: the role of endoscopy. Endoscopy. 2005;37:857–863. doi: 10.1055/s-2005-870192. [DOI] [PubMed] [Google Scholar]
  • 7.Singh A, Nachiappan A, Verma H. Postoperative imaging in liver transplantation: what radiologists should know. Radiographics. 2010;30:339–351. doi: 10.1148/rg.302095124. [DOI] [PubMed] [Google Scholar]
  • 8.Tung BY, Kimmey MB. Biliary complications of orthotopic liver transplantation. Dig Dis. 1999;17:133–144. doi: 10.1159/000016918. [DOI] [PubMed] [Google Scholar]
  • 9.Keogan MT, McDermott VG, Price SK, Low VH, Baillie J. The role of imaging in the diagnosis and management of biliary complications after liver transplantation. AJR. 1999;173:215–219. doi: 10.2214/ajr.173.1.10397129. [DOI] [PubMed] [Google Scholar]
  • 10.Hwang S, Lee S, Sung K. Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation. Liver Transpl. 2006;12:831–838. doi: 10.1002/lt.20693. [DOI] [PubMed] [Google Scholar]
  • 11.de la Mora-Levy JG, Baron T. Endoscopic management of the liver transplant patient. Liver Transpl. 2005;11:1007–1021. doi: 10.1002/lt.20547. [DOI] [PubMed] [Google Scholar]
  • 12.Rabkin JM, Orloff SL, Reed MH. Biliary tract complications of side-to-side without T tube versus end-to-end with or without T tube choledochocholedochostomy in liver transplant recipients. Transplantation. 1998;65:193–199. doi: 10.1097/00007890-199801270-00008. [DOI] [PubMed] [Google Scholar]
  • 13.Shah J, Haigh WG, Lee S. Biliary casts after orthotopic liver transplantation: clinical factors, treatment, biochemical analysis. Am J Gastroenterol. 2003;98:1861–1867. doi: 10.1111/j.1572-0241.2003.07617.x. [DOI] [PubMed] [Google Scholar]
  • 14.Verdonk R, Buis C, van der Jagt EJ. Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression. Liver Transpl. 2007;13:725–732. doi: 10.1002/lt.21165. [DOI] [PubMed] [Google Scholar]
  • 15.Scatton O, Meunier B, Cherqui D. Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation. Ann Surg. 2001;233:432–437. doi: 10.1097/00000658-200103000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Pfau PR, Kochman ML, Lewis JD. Endoscopic management of postoperative biliary complications in orthotopic liver transplantation. Gastrointest Endosc. 2000;52:55–63. doi: 10.1067/mge.2000.106687. [DOI] [PubMed] [Google Scholar]
  • 17.Gondolesi G, Varotti G, Florman S. Biliary complications in 96 consecutive right lobe living donor transplant recipients. Transplantation. 2004;77:1842–1848. doi: 10.1097/01.tp.0000123077.78702.0c. [DOI] [PubMed] [Google Scholar]
  • 18.Lee C, Liu N, Lee C. Endoscopic management of biliary complications after adult right-lobe living donor liver transplantation without initial biliary decompression. Transplant Proc. 2008;40:2542–2545. doi: 10.1016/j.transproceed.2008.08.030. [DOI] [PubMed] [Google Scholar]
  • 19.Welling T, Heidt D, Englesbe M. Biliary complications following liver transplantation in the model for end-stage liver disease era: effect of donor, recipient, and technical factors. Liver Transpl. 2008;14:73–80. doi: 10.1002/lt.21354. [DOI] [PubMed] [Google Scholar]
  • 20.Graziadei I, Schwaighofer H, Koch R. Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation. Liver Transpl. 2006;12:718–725. doi: 10.1002/lt.20644. [DOI] [PubMed] [Google Scholar]
  • 21.Ayoub W, Esquivel C, Martin P. Biliary complications following liver transplantation. Dig Dis Sci. 2010;55:1540–1546. doi: 10.1007/s10620-010-1217-2. [DOI] [PubMed] [Google Scholar]
  • 22.Guichelaar MMJ, Benson J, Malinchoc M, Krom RAF, Wiesner R, Charlton M. Risk factors for and clinical course of non-anastomotic biliary strictures after liver transplantation. Am J Transpl. 2003;3:885–890. doi: 10.1034/j.1600-6143.2003.00165.x. [DOI] [PubMed] [Google Scholar]
  • 23.Sharma S, Gurakar A, Jabbour N. Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl. 2008;14:759–769. doi: 10.1002/lt.21509. [DOI] [PubMed] [Google Scholar]
  • 24.Bourgeois N, Devire J, Yeaton P. Diagnostic and therapeutic endoscopic retrograde cholangiography after liver transplantation. Gastrointest Endosc. 1995;42:527–534. doi: 10.1016/s0016-5107(95)70005-6. [DOI] [PubMed] [Google Scholar]
  • 25.Park J, Kim M, Lee S. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation. Gastrointest Endosc. 2003;57:78–85. doi: 10.1067/mge.2003.11. [DOI] [PubMed] [Google Scholar]
  • 26.Scanga A, Kowdley K. Management of biliary complications following orthotopic liver transplantation. Curr Gastroenterol Rep. 2007;9:31–38. doi: 10.1007/s11894-008-0018-7. [DOI] [PubMed] [Google Scholar]
  • 27.Sheng R, Sammon JK, Zajko AB, Campbell WL. Bile leak after hepatic transplantation: cholangiographic features, prevalence, and clinical outcome. Radiology. 1994;192:413–416. doi: 10.1148/radiology.192.2.8029406. [DOI] [PubMed] [Google Scholar]
  • 28.Gor NV, Levy RM, Ahn J. Biliary cast syndrome following liver transplantation: predictive factors and clinical outcomes. Liver Transpl. 2008;14:1466–1472. doi: 10.1002/lt.21492. [DOI] [PubMed] [Google Scholar]
  • 29.Clavien PA, Camargo CA, Baillie J, Fitz JG. Sphincter of oddi dysfunction after liver transplantation. Dig Dis Sci. 1995;40:73–74. doi: 10.1007/BF02063944. [DOI] [PubMed] [Google Scholar]
  • 30.Thuluvath P, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation. Liver Int. 2003;23:156–162. doi: 10.1034/j.1600-0676.2003.00823.x. [DOI] [PubMed] [Google Scholar]

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