Liver transplantation: late complications of the biliary tract and their management

Even though the incidence of biliary complications has decreased over the years, the biliary tract is still a source of significant morbidity and graft failure in patients after liver transplantation. Biliary strictures and the secondary effects of obstruction make up the majority of complications that are identified at a time beyond the initial posttransplant hospitalization. Management of these complications has moved from a purely surgical realm to one involving invasive radiologic and endoscopic techniques. Expertise in procedural methodology has grown dramatically over the last 10 years. Prompt recognition of biliary complications and effective use of a combination of management techniques has resulted in improved palliation, greater graft salvage, and reduced patient mortality. Research into the pathogenesis and prevention of bile duct injury is needed.