Biliary Complications and Management After Liver Transplantation

To investigate the incidence, causes, and treatment methods of biliary complications (BC) following liver transplantation (LT).

Patients who underwent LT between February 1997 and 2024 were identified. Cases with BC were determined. Patients aged 18 years and older were classified as adults. Patients who experienced mortality within the first postoperative week or had spontaneous regression of bile drainage were excluded. The study aimed to evaluate the incidence and types of BC, complications associations between recipient/donor characteristics, graft type, steatosis, cold ischemia time (CIT), number of bile ducts, donor hepatectomy technique, and type of biliary reconstruction. Additionally, treatment methods, morbidity, and mortality rates were analyzed.

A total of 590 patients were included in the study. BC occurred in 49 patients (8.2%). In the multivariate analysis including all patients, living donor LT and prolonged CIT were identified as risk factors for the development of BC (P ≤ .001 and P ≤ .001, respectively). In the multivariate analysis conducted exclusively on cases who underwent LT due to cirrhosis, the factors associated with the development of BC were identified as living donor transplantation (P = .001), prolonged CIT (P ≤ .001), and viral etiology (P = .046). Complications were managed using endoscopic and interventional radiologic techniques. Mortality due to BC occurred in 19 (38.7%) of the cases.

BC are still a significant challenge in LT. Identifying and avoiding causative factors and strict selection criteria may substantially reduce the incidence of BC. Effective treatment can be achieved through a multidisciplinary approach in most cases.