Management of biliary complications in the liver transplant patient

Biliary complications after liver transplantation remain common. Resources for livers are limited, and these individuals are often ill, making nonoperative treatment and management attractive options. The endoscopic route for evaluation (endoscopic retrograde cholangiopancreatography) remains preferable, due to its safety profile, as opposed to the percutaneous route (percutaneous transhepatic cholangiography with percutaneous transhepatic biliary drainage), though the endoscopic route may not be possible in patients with a Roux-en-Y reconstruction. The two most common early complications include leaks from the anastomosis or cystic duct stump (of the donor or native duct) and obstruction at the surgical anastomosis. Nonoperative treatment is often successful in early complications. Late complications presenting with leaks and obstruction are often more difficult to treat nonoperatively and frequently require surgical treatment or retransplantation, though both endoscopic and percutaneous methods can be useful in the management of these complications or as a bridge to definitive surgical therapy.