Endoscopic management of biliary complications after orthotopic liver transplantation

Biliary complications after orthotopic liver transplantation are still a severe problem and often require a second surgical operation.

In our center we studied 500 patients after liver transplantation.

In this patient population, we found 44 patients suffering from diseases of the bile duct system after liver transplantation. Biliary complications were caused by stenoses which were localized most often in the common bile duct of the recipient (65%) but also in the common bile duct of the donor liver (26%) as well as in the anastomosis of common bile duct (9%). In all cases ERC was able to identify location, entity and dimension of the biliary complication thus leading to therapeutic strategy. 66% (27 out of 41) of the patients with biliary complication could be cured definitely by endoscopic methods alone while 29% (12 out of 41) of these patients needed surgical operation and 5% (2 out of 41) received both, endoscopic and surgical therapy. Patients suffering from multiple complications could be cured partially by endoscopic methods improving patient condition for subsequent surgery. Ischemic type biliary lesions of the extrahepatic ducts (ITBL type I) as well as of the intrahepatic ducts (ITBL type II) could be successfully treated by endoscopy. Only rare cases of multiple lesions intra- and extrahepatically due to ITBL type III gave no chance to endoscopy and demanded directly surgical operation.

Our results show that most of the biliary complications after liver transplantation can be resolved by endoscopic treatment.