Post-transplant biliary complications: advances in pathophysiology, diagnosis, and treatment

Abstract

Liver transplantation (LT) is the only curative therapy in patients with end-stage liver disease. Long-term survival is excellent, yet LT recipients are at risk of significant complications. Biliary complications are an important source of morbidity after LT, with an estimated incidence of 5%-32%. Post-LT biliary complications include strictures (anastomotic and non-anastomotic), bile leaks, stones, and sphincter of Oddi dysfunction. Prompt recognition and management is critical as these complications are associated with mortality rates up to 20% and retransplantation rates up to 13%. This review aims to summarise our current understanding of risk factors, natural history, diagnostic testing, and treatment options for post-transplant biliary complications.

Keywords: bile duct surgery; biliary strictures; endoscopic retrograde pancreatography; hepatobiliary surgery; liver transplantation.

Figure 1

Image showing a single, severe anastomotic biliary stricture with duct disruption and subsequent bile leak found at the post-transplant anastomosis.

Figure 2

Fluoroscopic image demonstrating a severe anastomotic stricture (A) following endoscopic placement of plastic stent across the anastomotic site (B).

Figure 3

Fluoroscopic image demonstrating several areas of narrowing and dilatation representing non-anastomotic strictures. There is also bile duct filling defect seen in the distal common bile duct likely representing a gallstone in the recipient duct.