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Biliary Complications and Management After Liver Transplantation
Tufan Egeli1, Ibrahim Kemal Astarcioglu2, Tarkan Unek1
1General Surgery, Dokuz Eylul University Medical Faculty, Izmir, Turkiye.
Transplantation Proceedings
|July 31, 2025
Summary
Biliary complications (BC) affect 8.2% of liver transplant (LT) patients, with living donor LT and prolonged cold ischemia time (CIT) as key risk factors. Early intervention and strict selection can mitigate these challenges.
Area of Science:
- Hepatology
- Transplant Surgery
- Gastroenterology
Background:
- Biliary complications (BC) remain a significant challenge after liver transplantation (LT).
- Understanding the risk factors and effective management strategies for BC is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence, causes, and treatment of BC following LT.
- To identify risk factors associated with BC development, including donor and recipient characteristics, graft type, and surgical factors.
- To analyze treatment modalities, morbidity, and mortality rates associated with BC.
Main Methods:
- Retrospective analysis of 590 adult patients undergoing LT between February 1997 and 2024.
- Exclusion of patients with early postoperative mortality or spontaneous bile drainage regression.
- Evaluation of incidence, types of BC, and associations with recipient/donor factors, graft characteristics, cold ischemia time (CIT), and biliary reconstruction techniques.
Main Results:
- BC occurred in 8.2% of patients (49/590).
- Living donor LT and prolonged CIT were significant risk factors for BC in the overall cohort (P ≤ .001).
- In cirrhosis-specific LT, living donor transplantation (P = .001), prolonged CIT (P ≤ .001), and viral etiology (P = .046) were associated with BC. Mortality due to BC was 38.7%.
Conclusions:
- Biliary complications continue to pose a significant challenge in liver transplantation.
- Identifying and mitigating risk factors, alongside strict patient selection, can reduce BC incidence.
- A multidisciplinary approach is effective for managing BC in most liver transplant recipients.
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