Post-transplant cholangiopathy: Classification, pathogenesis, and preventive strategies

Area of Science:

• Hepatology
• Transplantation Surgery
• Gastroenterology

Background:

• Biliary complications are a leading cause of morbidity and mortality post-liver transplantation.
• Existing definitions for non-anastomotic biliary strictures (NAS) lack consensus.
• Biliary leakage, strictures, and bilomas are common issues affecting graft survival.

Purpose of the Study:

• To propose a unified term, post-transplant cholangiopathy, for a spectrum of biliary abnormalities.
• To review the pathogenesis, clinical implications, and prevention of these complications.
• To establish a clearer understanding of biliary issues following liver transplantation.

Main Methods:

• Literature review of post-transplant biliary complications.
• Analysis of proposed definitions and diagnostic criteria for NAS.
• Synthesis of current understanding regarding the etiology of cholangiopathy.

Main Results:

• Post-transplant cholangiopathy is proposed to encompass NAS, intraductal casts, and intrahepatic bilomas with a patent hepatic artery.
• Ischemia-reperfusion injury is identified as a primary underlying mechanism.
• Bile salt toxicity and immune-mediated injury also contribute to its development.

Conclusions:

• A standardized definition of post-transplant cholangiopathy is crucial for consistent diagnosis and management.
• Understanding the multifactorial pathogenesis aids in developing preventive strategies.
• Addressing these biliary complications is vital for improving liver transplant success rates.