Biliary complications following liver transplantation

Abstract

Biliary tract complications are the most common complications after liver transplantation. These complications are encountered more commonly as a result of increased number of liver transplantations and the prolonged survival of transplant patients. Biliary complications remain a major source of morbidity in liver transplant patients, with an incidence of 5%-32%. Post liver transplantation biliary complications include strictures (anastomotic and non-anastomotic), leaks, stones, sphincter of Oddi dysfunction, and recurrence of primary biliary disease such as primary sclerosing cholangitis and primary biliary cirrhosis. The risk of occurrence of a specific biliary complication is related to the type of biliary reconstruction performed at the time of liver transplantation. In this article we seek to review the major biliary complications and their relation to the type of biliary reconstruction performed at the time of liver tranplantation.

Management of Duct to Duct Biliary Anastomotic Stricture with Modified Roux En Y Hepaticojejunostomy in Post-Transplant Biliary Stricture - A Novel Surgical Technique

“…Incidence of biliary complications over the past two decades have dramatically come down owing to the advancements in the technique of biliary anastomosis, technical expertise, better suture materials, use of intra operative cholangiograms, avoiding revascularization of ductal structures etc [4]. However, world over the reported incidence of biliary complications is 5% to 32% [5].…”

Remedy Experience of Severe Abdominal Infection after Orthotopic Liver Transplantation

“…Liver transplant patients are more susceptible to severe abdominal infections than other abdominal surgery patients. Severe abdominal infections after liver transplantation often caused systemic inflammatory response syndrome and cardiopulmonary dysfunction, liver and kidney dysfunction, pyemia, or even septicaemia, which are the most common causes of death in perioperative liver transplantation (3)(4)(5).…”

“…Severe abdominal infections after liver transplantation are commonly caused by extensive bleeding after liver transplant and sometimes by gastrointestinal fistulae, which are the results of surgically injured gastrointestinal tract or infectioninduced enteron diabrosis (2,3,11,12). It may be difficult to identify such injury in the early stage.…”

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“…1,2 Additionally, the incidence of biliary anastomotic stricture developing within 5 to 8 months after a liver transplant ranges from 16% to 32%. 3 The incidence of anastomotic biliary stricture because of the placement of stents by endoscopic retrograde cholangiopancreatography ranges from 0% to 24%. Complications of these strictures include leakage, cholangitis, pancreatitis, and bleeding related to sphincteroplasty.…”