Management of biliary tract complications after orthotopic liver transplantation

Abstract

The incidence of biliary complications has decreased with time. The abandonment of choledocho-choledochostomy over a T-tube has been justified. A combination of conservative, endoscopic, and radiological management has been effective in treating biliary leaks and early anastomotic stricture. However endoscopic or radiological stenting was ineffective in the management of late anastomotic strictures, which were best treated by surgical intervention.

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“…The dramatic improvement in posttransplant patient survival over the past few decades has been attributed to a variety of factors, including refined surgical and organ preservation techniques, better immunosuppression protocols, more efficient treatment of infections, and improved perioperative care. [1][2][3] However, despite the recent advances in this field, liver transplant is still associated with many complications, including bleeding, vascular com plications, biliary complications, primary graft nonfunction, small-forsize syndrome, graft rejection, and others. 4 Biliary complications remain one of the most common and the most worrisome problems in liver transplant recipients.…”

Ischemic Type Biliary Lesions

“…Although patients transplanted due to PSC may also develop ITBL, no diagnostic method can definitively guarantee the differentiation between ITBL and PSC-recurrence. Therefore, the relatively high chance of misclassification regarding patient cohorts undergoing statistical analysis of etiologic risk factors including epidemiologic aspects may explain differences in ITBL-incidence reported in the literature [10,74]. After the exclusion of PSC-patients and managed post-transplant vascular complications the incidence of ITBL is supposed to be much lower than 20% [27,40,47,75].…”

“…Endoscopic or radiological dilatation of strictures has been shown to be ineffective in some patients, who may profit from surgical treatment [10]. Therefore, reconstructive surgical approach should be reserved to ITBL patients not responsive to endoscopic or trans-hepatic interventions [2].…”

“…Modern ITBL-treatment strategy comprises a multimodal approach and an excellent cooperation between departments of radiology, endoscopy and surgery ( fig. 6) [2,10,25]. In most cases the treatment of strictures is performed conservatively by endoscopic or transhepatic dilatation [24,33,40].…”

The application of SpyScope® technology in evaluation of pre and post liver transplant biliary problems

“…In fact, strictures following OLTx are reported to be the commonest biliary problems, with incidences reported as 5-15% for non-anastomotic strictures and 4-9% for anastomotic strictures (11)(12)(13)15). The conventional approach to the management of biliary stricture is endoscopic dilatation followed by stenting (14).…”