Biliary complications after liver transplantation

Liver transplantation (LT) has become the established means of treating patients with end-stage liver disease. However, biliary complications remain a significant cause of postoperative morbidity and possibly mortality. Biliary strictures and leaks are the most common complications following liver transplantation. The incidence of biliary tract complications after orthotopic LT (OLT) varies from 11% to 34%. The reported incidence of biliary complications is 5–15% after deceased donor liver transplantation (DDLT) and 20–34% after right lobe living-related liver transplant (LRLT). There are several predisposing risk factors for development of biliary complications post transplant with a higher risk in LRLT compared to DDLT. Bile duct strictures occur in 4–13% of patients after DDLT and account for approximately 40% of all biliary complications where as the incidence of biliary leaks after LT ranges between 2% and 25%. Biliary strictures after liver transplantation have been classified as anastomotic strictures (AS) and non-anastomotic strictures (NAS). Most bile leaks and strictures can be resolved nonoperatively with early endoscopic intervention. Endoscopic retrograde cholangiopancreatography (ERCP) is the first line treatment at our center for both bile leaks as well strictures. However, in spite of excellent results surgery is required in small proportion of patients.