[Biliary complications after liver transplantation. Contribution of imaging--percutaneous treatment]

Biliary complications are observed in 7 to 20% of orthotopic liver transplantations. Biliary strictures and fistulas are the commonest complications, usually at the site of anastomoses, or more rarely at a distance. The entire transplant biliary tract may be affected, particularly in the case of hepatic artery thrombosis. These lesions are due to multifactorial ischaemic phenomena. Mechanical complications can occur after insertion of a Kehr drain. Mucoceles of the cystic duct, responsible for extrinsic bile duct compression, are much less common. The diagnosis is based on medical imaging, as the clinical signs are often non-specific. Ultrasonography has limited sensitivity as a first-line examination. Opacification of the bile ducts is therefore essential at the slightest doubt, as it has a sensitivity of 100% and allow assessment of the lesions. Transhepatic cholangiography is preferable to retrograde opacification due to the risks infection. CT scan is useful in the case of fistula to assess fluid collections. Percutaneous treatment avoids the need for open surgery in about 1/3 of cases. Strictures can be dilated by means of inflatable balloons, via a percutaneous or retrograde approach. Intra-abdominal collections can be drained percutaneously.