Management of biliary problems after liver transplantation

1. Biliary complications of some type occur in approximately one of every eight liver transplant recipients. Although they are uncommon causes of mortality, they are significant sources of morbidity. 2. Leaks and strictures that occur early after transplantation have technical causes. Late strictures and obstruction are more likely to be complex and have multiple causes, including hepatic artery occlusion, preservation injury, rejection, and recurrent disease. 3. Diagnosis relies on abdominal imaging and cholangiographic studies. Patency of the hepatic artery must be proven when a complication of the donor biliary tree occurs. 4. Management of late complications is largely influenced by the nature and extent of strictures. Percutaneous and endoscopic treatment of anastomotic strictures offers a significant prospect of successful long-term management. 5. Nonsurgical management of more complex hilar and intrahepatic strictures is less successful, and surgical revision or retransplantation may be required for definitive treatment.