Biliary Complications in Liver Transplant Recipients With a History of Bariatric Surgery

Bariatric surgery can greatly ameliorate obesity and its associated metabolic disorders. Alteration of foregut anatomy, as is seen after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch, renders traditional access to the biliary tree difficult, if not impossible. This may complicate management of anastomotic biliary complications after liver transplant.

In this single-center study, we retrospectively reviewed all adult patients with a history of any bariatric surgery who underwent liver transplant during the period January 2017 to December 2022. We obtained demographic information of donors and recipients. Outcomes of interest included the modality in which the anastomotic biliary complications were managed.

Of 261 patients who underwent liver transplant at our center during the study period, 9 had a history of bariatric surgery. Anastomotic biliary complications occurred in 3 of 9 patients (33%). No significant differences were shown in donor age, ischemia time, etiology of liver disease, or Model for End-Stage Liver Disease sodium score at time of transplant between the 2 groups. All anastomotic biliary complications occurred in patients with a history of Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch. Interventions included advanced endoscopy, endoscopic ultrasonography, and lumen-apposing metal stent to access the remnant stomach and biliopancreatic limb (n = 2) and surgical revision following percutaneous transhepatic biliary drain placement (n = 1). At the end of the study, none experienced recurrent stricture.

Anastomotic biliary complications are well-described after liver transplant. A multidisciplinary approach with interventional radiology and inter-ventional gastroenterology can be beneficial to address strictures that arise in recipients with a history of Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch.