A Review on the Management of Biliary Complications after Orthotopic Liver Transplantation

Abstract

Orthotopic liver transplantation is the definitive treatment for end-stage liver disease and hepatocellular carcinomas. Biliary complications are the most common complications seen after transplantation, with an incidence of 10-25%. These complications are seen both in deceased donor liver transplant and living donor liver transplant. Endoscopic treatment of biliary complications with endoscopic retrograde cholangiopancreatography (commonly known as ERCP) has become a mainstay in the management post-transplantation. The success rate has reached 80% in an experienced endoscopist's hands. If unsuccessful with ERCP, percutaneous transhepatic cholangiography can be an alternative therapy. Early recognition and treatment has been shown to improve morbidity and mortality in post-liver transplant patients. The focus of this review will be a learned discussion on the types, diagnosis, and treatment of biliary complications post-orthotopic liver transplantation.

Keywords: Bile leak; Biliary tract complication; Orthotropic liver transplantation; Stricture.

Fig. 1.. Anastomotic stricture 10 months after orthotropic liver transplantation.

Fig. 2.. Placement of 10 mm × 6 cm partially covered self-expanding metal stent traversing the stricture.

Fig. 3.. Bile leak 4 months after orthotropic liver transplantation.

Fig. 4.. Successful placement of two 10 Fr × 9 cm plastic stents traversing bile leak.

Fig. 5.. Resolution of bile leak 2 months after placement.

Fig. 6.. Decision tree for managing biliary complications after orthotropic liver transplantation., Abbreviations: ERCP, endoscopic retrograde cholangiopancreatography; fcSEMS, fully covered self-expanding metal stent; PTC, percutaneous transhepatic cholangiography; SEMS, self-expanding metal stent.