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Review
. 2021 Jan;10(1):76-92.
doi: 10.21037/hbsn.2019.09.01.

Biliary complications after liver transplantation: current perspectives and future strategies

Bianca Magro  1   2 , Matteo Tacelli  1 , Alessandra Mazzola  2 , Filomena Conti  2 , Ciro Celsa  1
Affiliations
Review

Biliary complications after liver transplantation: current perspectives and future strategies

Bianca Magro et al. Hepatobiliary Surg Nutr. 2021 Jan.

Abstract

Importance: Liver transplantation (LT) is a life-saving therapy for patients with end-stage liver disease and with acute liver failure, and it is associated with excellent outcomes and survival rates at 1 and 5 years. The incidence of biliary complications (BCs) after LT is reported to range from 5% to 20%, most of them occurring in the first three months, although they can occur also several years after transplantation.

Objective: The aim of this review is to summarize the available evidences on pathophysiology, risk factors, diagnosis and therapeutic management of BCs after LT.

Evidence review: a literature review was performed of papers on this topic focusing on risk factors, classifications, diagnosis and treatment.

Findings: Principal risk factors include surgical techniques and donor's characteristics for biliary leakage and anastomotic biliary strictures and vascular alterations for non- anastomotic biliary strictures. MRCP is the gold standard both for intra- and extrahepatic BCs, while invasive cholangiography should be restricted for therapeutic uses or when MRCP is equivocal. About treatment, endoscopic techniques are the first line of treatment with success rates of 70-100%. The combined success rate of ERCP and PTBD overcome 90% of cases. Biliary leaks often resolve spontaneously, or with the positioning of a stent in ERCP for major bile leaks.

Conclusions and relevance: BCs influence morbidity and mortality after LT, therefore further evidences are needed to identify novel possible risk factors, to understand if an immunological status that could lead to their development exists and to compare the effectiveness of innovative surgical and machine perfusion techniques.

Keywords: Liver transplantation (LT); biliary tract diseases; cholangiography; cholangiopancreatography endoscopic retrograde; review.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/hbsn.2019.09.01). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Biliary complications after liver transplantation.
Figure 2
Figure 2
Risk factors for biliary complications after liver transplantation.
Figure 3
Figure 3
Diagnostic flow-chart of biliary complications after liver transplantation.
See this image and copyright information in PMC

Comment in

References

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