Biliary complications after liver transplantation: old problems and new challenges

Area of Science:

• Hepatobiliary Surgery
• Transplantation Medicine
• Gastroenterology

Background:

• Biliary complications represent a major cause of morbidity following liver transplantation (LT).
• These complications manifest as anastomotic or nonanastomotic biliary strictures, impacting donor biliary system integrity.
• Key risk factors include older donor age, marginal grafts, prolonged ischemia, and specific LT types like living donor liver transplantation (LDLT) and donation after cardiac death (DCD).

Purpose of the Study:

• To review the current understanding of biliary complications after liver transplantation.
• To highlight risk factors, diagnostic modalities, and treatment strategies for biliary strictures.
• To emphasize the challenges posed by nonanastomotic strictures and their impact on graft survival.

Main Methods:

• Review of noninvasive imaging studies such as Magnetic Resonance Imaging (MRI) and Magnetic Resonance Cholangiopancreatography (MRCP).
• Discussion of direct cholangiography as the gold standard for diagnosis.
• Emphasis on a multidisciplinary treatment approach, particularly for nonanastomotic strictures.

Main Results:

• Anastomotic strictures show high success rates with interventional management and surgical revision when necessary.
• Nonanastomotic biliary strictures present a significant challenge, often requiring complex multidisciplinary approaches.
• Despite advancements, a notable number of graft failures remain inevitable in cases of nonanastomotic strictures.

Conclusions:

• Biliary complications are a critical concern in liver transplantation, with nonanastomotic strictures posing a substantial threat to graft survival.
• While anastomotic strictures are manageable, nonanastomotic strictures necessitate advanced, multidisciplinary strategies.
• Further research and improved prophylactic measures are needed to mitigate the impact of biliary complications, especially those arising from nonanastomotic strictures.