Management of biliary complications after LDLT

Area of Science:

• Hepatology
• Gastroenterology
• Transplantation Surgery

Background:

• Biliary complications (BC) are a significant unresolved issue in living donor liver transplantation (LDLT).
• Bile leaks (BL) and biliary anastomotic strictures (BAS) are the most frequent BCs, with BAS accounting for approximately 80% of cases.
• While endoscopic retrograde cholangiography (ERC) and percutaneous transhepatic cholangiography (PTC) with percutaneous transhepatic biliary drainage (PTBD) are effective, challenges remain.

Purpose of the Study:

• To summarize pertinent issues and novel insights regarding biliary complications following LDLT.
• To propose basic principles for managing the spectrum of biliary complications after LDLT.
• To address unanswered questions concerning prediction of endoscopic success, stent management, and long-term outcomes in high-grade strictures.

Main Methods:

• Review of current literature on biliary complications in LDLT.
• Analysis of established and emerging treatment modalities including ERC and PTBD.
• Synthesis of data to identify knowledge gaps and propose management strategies.

Main Results:

• Endoscopic and percutaneous interventions are successful in managing a majority of BCs.
• Key unanswered questions include predicting endoscopic success, optimizing stent duration, and managing high-grade strictures.
• Long-term outcomes for patients requiring intervention for BCs require further investigation.

Conclusions:

• Effective management of biliary complications in LDLT relies on a combination of endoscopic and percutaneous techniques.
• Further research is needed to address prediction of treatment difficulty, optimal stent management, and long-term outcomes.
• Adherence to proposed principles can guide the management of diverse biliary complications post-LDLT.