Biliary Complications after Liver Transplantation: the Role of Endoscopy

Abstract

Biliary complications are important causes of early and late postoperative morbidity and mortality after liver transplantation and are seen in 10-20 % of the patients. The common biliary complications include bile leaks, stones or debris, and anastomotic strictures. Less common complications are hilar strictures, intrahepatic strictures, and papillary stenosis/dysfunction. The complications are similar in living-donor and cadaveric liver transplantations, except for a higher incidence of bile leaks among living-donor transplant recipients. The clinical presentation of post-liver transplant bile duct complications is often subtle, and noninvasive imaging studies may sometimes fail to detect mild but clinically significant stenoses or small leaks. Early recognition and prompt treatment of biliary complications following liver transplantation reduces the morbidity and improves long-term graft and patient survival. In this report, we discuss the role of endoscopy in the diagnosis, treatment options, and the outcome for patients with biliary complications following liver transplantation.

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

“…However, even with dilatation alone, good long-term results have been reported with a lower risk of bacterial cholangitis (9). The standard procedure in our center as well as in many other centers (17,42) is repetitive balloon dilatation (every 2-3 months) mostly with parallel stenting (two or three 10 to 12F stents). In case of an adequate treatment response the stents are removed after 3 (18) to 12 months followed by early control ERC.…”

“…rejection, CMV-hepatitis) a liver biopsy might be useful. Additional investigations like hepatobiliary scintigraphy (HIDA-scan) have been described with controversial results (16) and are rarely used in the routine workup nowadays (17).…”

“…Thereby, the incidence after Living Donor Liver Transplantation (LDLT) was higher than after full-size LT (9.5% vs. 7.8%). The majority of bile leaks are either seen in the first month after LT or after T-tube removal (17). Late forms until 6 months are occasionally reported (20).…”

“…AS in the early course are often a result of surgical failure, whereas late AS may develop gradually as consequence of local inflammation due to ischemia, bile leaks and other factors. Clinical manifestation takes place within 6 months (9,17), but occasionally also after many years (17,20). Verdonk reported a cumulative incidence of 6.6%, 10.6%, and 12.3% after 1, 5 and 10 years, respectively (18).…”

“…In patients with bilioenteric anastomosis balloon dilatation is performed percutaneously (17,43). Additionally, Yamakawa drains (49,50) with increasing size are often used in the own practice for 6-12 months.…”