Biliary complications in orthotopic liver transplantation: mechanism, diagnosis and treatment

Biliary complications(BC) are a major cause of morbidity in liver transplant recipients with an incidence of 10∼30% following orthotopic liver transplantation(OLT), and a mortality rate of up to 10%. The most common biliary complications are bile leaks, biliary strictures, ampullary dysfunction, and stones. Leaks predominate in the early posttransplant period; while stricture formation typically develops gradually over time. Risk factors for biliary complications comprise technical failure, T-tube-related complications, hepatic artery thrombosis, bleeding, ischemia/reperfusion injury, primary diseases, and other immunological, non-immunological, and infectious complications. Cholangiography, such as endoscopic retrograde cholangiopancreatography(ERCP) or percutaneous transhepatic cholangiogram(PTC), is considered the gold standard for identifying post-transplant BC. The management of biliary complications after OLT requires a multidisciplinary approach, in which interventional radiology and endoscopic techniques are emerging as the preferred treatment option, but in a selected majority of patients, surgery is still necessary.