Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: a systematic review of the incidence, risk factors and outcome

Abstract

Summary Biliary reconstruction remains common in postoperative complications after liver transplantation. A systematic search was conducted on the PubMed database and 61 studies of retrospective or prospective institutional data were eligible for this review. The study comprised a total of 14 359 liver transplantations. The overall incidence of biliary stricture was 13%; 12% among deceased donor liver transplantation (DDLT) patients and 19% among living donor liver transplantation (LDLT) recipients. The overall incidence of biliary leakage was 8.2%, 7.8% among DDLT patients and 9.5% among LDLT recipients. An endoscopic strategy is the first choice for biliary complications; 83% of patients with biliary stricture were treated by endoscopic modalities with a success rate of 57% and 38% of patients with leakage were indicated for endoscopic biliary drainage. T‐tube placement was not performed in 82% of duct‐to‐duct reconstruction. The incidence of biliary stricture was 10% with a T‐tube and 13% without a T‐tube and the incidence of leakage was 5% with a T‐tube and 6% without a T‐tube. A preceding bile leak and LDLT procedure are accepted risk factors for anastomotic stricture. Biliary complications remain common, which requires further investigation and the refinement of reconstruction techniques and management strategies.

Biliary Complications after Liver Transplantation

“…Our biliary complication rate of 26.9% is similar to other studies 1,9,13,20 . Living donor liver transplantation was almost two times the rate of cadaveric transplantation.…”

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

“…The majority of bile leaks are either seen in the first month after LT or after T-tube removal (17). Late forms until 6 months are occasionally reported (20). A recent analysis (19) suggested, that the incidence of bile leaks has decreased from 7.5% in the pre-MELD to 4.9% in the MELD era (p = 0.02).…”

“…The reported incidence of AS is 13% after full size and 19% after LDLT (20). AS in the early course are often a result of surgical failure, whereas late AS may develop gradually as consequence of local inflammation due to ischemia, bile leaks and other factors.…”

“…Major risk factors are inadequate surgical technique, arterial complications or local ischemia of the donor bile duct, the type of biliary reconstruction and the type of liver graft (partial vs. whole LT). Moreover, a preceding bile leak is associated with later AS (18)(19)(20) (19). This is supposed to be multifactorial, since donor age was older and the incidence of hepatic artery thrombosis (HAT) higher in the post-MELD era.…”

“…AS in the early course are often a result of surgical failure, whereas late AS may develop gradually as consequence of local inflammation due to ischemia, bile leaks and other factors. Clinical manifestation takes place within 6 months (9,17), but occasionally also after many years (17,20). Verdonk reported a cumulative incidence of 6.6%, 10.6%, and 12.3% after 1, 5 and 10 years, respectively (18).…”