[Biliary complications following liver transplantation]

Area of Science:

• Hepatobiliary Surgery
• Transplantation Medicine
• Gastroenterology

Context:

• Biliary complications (BC) represent a significant challenge in liver transplantation, contributing substantially to patient morbidity.
• The type of biliary reconstruction technique critically influences patient outcomes and graft survival.
• Frequent BCs include stenoses, leaks, bilomas, and cholangitis, with a peak incidence in the first six months post-transplant.

Purpose:

• To review the incidence, risk factors, and management strategies for biliary complications following liver transplantation.
• To highlight the evolving role of interventional radiology and endoscopy in treating BCs.
• To delineate the circumstances necessitating surgical intervention for managing complex biliary issues.

Summary:

• Key risk factors for BC include hepatic artery pathology, partial liver grafts, bilioplasty, and multiple biliary anastomoses.
• Management strategies range from conservative approaches to interventional (endoscopic/radiological) and surgical methods.
• Advancements in non-surgical techniques have improved the successful treatment rate of many BCs.

Impact:

• Early diagnosis and prompt application of various therapeutic methods, especially non-surgical interventions, significantly reduce the impact of BC on patient mortality.
• While BC contributes to morbidity, effective management strategies ensure it does not typically lead to increased mortality.
• Surgical intervention remains crucial for specific complex cases like persistent leaks or multiple stenoses, particularly with partial grafts or hepatic artery issues.