title: Biliary tract complications after liver transplantation: a review.
abstract: Biliary complications continue to be a major cause of morbidity in liver transplant recipients with an incidence of 10-30% following whole-organ transplantation and a mortality rate of up to 10%. Biliary leaks and strictures are most common but sphincter of Oddi dysfunction, hemobilia, and biliary obstruction are also observed. Biliary complications may be related to various factors such as hepatic artery patency, preservation injury, cytomegalovirus infection, chronic ductopenic rejection, ABO incompatibility, and technical reasons. The latter include imperfect anastomosis, T-tube-related complications and the use of partial liver grafts when cut surface biliary leaks or inadvertent bile duct injuries may occur during parenchymal division. The usage of a T-tube for duct-to-duct anastomosis in whole-organ liver transplantation remains controversial, mainly because of the high rates of T-tube-related complications observed in many series. In this article we review the etiology, as well as the main types of biliary complications according to the technique of biliary reconstruction and liver transplant procedure performed. Their management is also discussed with interventional radiology and endoscopic techniques emerging as the preferred treatment option, obviating the need for surgery in a selected majority of patients.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of General and Transplant Surgery, M. Curie Hospital, Szczecin, Poland. drmwojcicki@wp.pl
authors.forename: Maciej
authors.initials: M
authors.lastname: Wojcicki
authors.forename: Piotr
authors.initials: P
authors.lastname: Milkiewicz
authors.forename: Michael
authors.initials: M
authors.lastname: Silva
mesh_terms: D000017:ABO Blood-Group System; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001652:Bile Ducts / Q000293:injuries* / Q000473:pathology*; D015209:Cholangitis, Sclerosing / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D003586:Cytomegalovirus Infections / Q000209:etiology; D006431:Hemobilia / Q000209:etiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D009803:Sphincter of Oddi / Q000503:physiopathology; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System