title: Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: a systematic review of the incidence, risk factors and outcome.
abstract: 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.
authors.affiliation: Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Akamatsu
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Daijo
authors.initials: D
authors.lastname: Hashimoto
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000628:therapy; D001652:Bile Ducts / Q000601:surgery*; D001660:Biliary Tract Diseases / Q000209:etiology*; D002102:Cadaver; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D004322:Drainage / Q000379:methods; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D019651:Plastic Surgery Procedures; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome