Biliary Tract Strictures after Orthotopic Liver Transplantation: Diagnosis and Management

Abstract

Biliary tract complications in 105 patients who had undergone orthotopic liver transplantation were reviewed in order to determine their incidence and localization. In addition, the possible endoscopic and percutaneous management of such complications was evaluated. Signs of cholestasis appeared in 32 of 105 (30.5%) transplant recipients after a mean of 6.5 months (range 1-19 months), and visualization of the biliary system was performed in all. Twenty biliary tract complications were observed in these 32 patients (62.5%). There were multiple strictures, both intrahepatic and extrahepatic, in 11 grafts. Five of the nine extrahepatic strictures were not confined to the site of the bile duct anastomosis, and involved the whole common bile duct of the donor liver, while the remaining four were confined. The multiple intrahepatic and extrahepatic strictures were related either to occlusion of the hepatic artery or to the fact that the graft had been in a cold ischemic state for a prolonged time. In contrast, multiple strictures and necrosis of the whole extrahepatic bile duct were attributed to local ischemia due to the harvesting procedure. Stenoses strictly confined to the site of anastomosis were thought to be due to surgical technique. Ten extrahepatic bile duct stenoses with considerably impaired bile flow were corrected endoscopically (four), percutaneously (three) and by surgery (three). In four patients with complications in the whole intrahepatic and extrahepatic system, retransplantation was necessary. Biliary tract complications in our patients occurred in up to 19% after liver transplantation on long-term follow-up. Complications of only the extrahepatic system can be treated successfully, whereas complications involving multiple stenoses of the intrahepatic bile duct system frequently require retransplantation.

Evaluation of the efficacy and reproducibility of cholangiopancreatography by magnetic resonance for detecting biliary complications following orthotopic liver transplantation

“…The prevalence rate for biliary complications in the study group was 21.43%, which was within the range of 10-30% that has been observed in the studies published on this topic so far [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] .…”

“…Among these, biliary complications have been highlighted, with incidence rates ranging from 1 to 50% in different published series, and mostly between 10 and 30% [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] . The postoperative period following orthotopic liver transplantation (OLT) is a challenge for transplantation teams, because the clinical and laboratory manifestations of the various potential complications from this procedure present a high degree of overlap.…”

Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression

“…Previously, others have described successful treatment of NAS with a number of modalities. 3,[14][15][16][17] We did not study the success of treatment in these patients because the group of patients treated with therapeutic ERCP, PTCD, or surgery was too small (28 cases), the group was heterogeneous concerning location and severity of abnormalities, and several types of treatment modalities were used. However, in most patients, an improvement in liver test results was seen, although this is not synonymous with uneventful longterm outcome.…”

“…Nineteen had to be admitted repeatedly for recurrent bacterial cholangitis (defined as 3 or more episodes). The median number of cholangitis episodes in these 19 was 5 (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Thirty patients were placed on maintenance antibiotic therapy, mostly ciprofloxacin, for some time.…”

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

“…Owing to prognostic and therapeutic implications, extrahepatic lesions (type I) are distinguished from intrahepatic (type II) or a combination of intra-and extrahepatic abnormalities (62,63). Since mainly the extent of intrahepatic alterations is relevant for the treatment success ( Figure 5), Buis et al have suggested a classification of the involved intrahepatic zones A to D (54), Figure 3).…”