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Biliary complications after liver transplantation

  • Sanjay Jagannath
  • Anthony N. Kalloo
Article

Opinion statement

  • The incidence of biliary complications after liver transplant is estimated to be 8% to 20%. Post-liver transplant biliary complications may lead to acute and chronic liver injury. The early recognition and prompt treatment of such complications improves the long-term survival of the patient and graft.

  • An understanding of the type of biliary reconstruction, the rationale for creating a particular anastomosis, and the technical difficulties in reconstructing the biliary tract are important in assessing and managing complications after liver transplant. Because the clinical presentation of these patients may be subtle, the physician must be aggressive and thoughtful in ordering and interpreting the diagnostic tests. Important points to remember are 1) that noninvasive examinations may fail to detect small obstructions or leaks, 2) a liver biopsy often is performed prior to cholangiography to exclude rejection and ischemia, and 3) the liver biopsy can miss an extrahepatic obstruction by misinterpreting portal inflammation as rejection.

  • Biliary leaks and strictures are the most common biliary complications following liver transplant. Less common complications include ampullary dysfunction and stone/sludge formation. The effective management of biliary complications following a liver transplant depends on understanding the natural history, the prognosis, and the available therapeutic options for each type of complication.

Keywords

Bile Duct Liver Transplantation Biliary Tract Orthotopic Liver Transplantation Bile Leak 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References and Recommended Reading

  1. 1.
    Tung BY, Kimmey MB: Biliary complications of orthotopic liver transplantation. Dig Dis 1999, 17:133–144.PubMedCrossRefGoogle Scholar
  2. 2.
    Cheng YF, Chen YS, Huang TL, et al.: Biliary complications in living related liver transplantation. Chang Gung Med J 2001, 24:174–180.PubMedGoogle Scholar
  3. 3.
    Van Thiel DH, Fagiuoli S, Wright HI, et al.: Biliary complications of liver transplantation. Gastrointestinal Endoscopy 1993, 39:455–460.PubMedGoogle Scholar
  4. 4.
    Stratta RJ, Wood RP, Langnas AN, et al.: Diagnosis and treatment of biliary tract complications after orthotopic liver transplantation. Surgery 1989, 106:675–684.PubMedGoogle Scholar
  5. 5.
    Ostroff JW: Post-transplant biliary problems. Gastrointest Endosc Clin N Am 2001, 11:163–183. An excellent, up to date review of the various biliary complications.PubMedGoogle Scholar
  6. 6.
    Sung JY, Costerton JW, Shaffer EA: Defense system in the biliary tract against bacterial infection. Dig Dis Sci 1992, 37:689–696.PubMedCrossRefGoogle Scholar
  7. 7.
    Hiatt JR, Quinones-Baldrich WJ, Ramming KP, et al.: Operations upon the biliary tract during transplantation of the liver. Surg Gynecol Obstet 1987, 165:89–93.PubMedGoogle Scholar
  8. 8.
    Porayko MK, Kondo M, Steers JL: Liver transplantation: late complications of the biliary tract and their management. Semin Liver Dis 1995, 15:139–155. A thorough review of early and late biliary complications.PubMedGoogle Scholar
  9. 9.
    Langnas AN, Marujo W, Stratta RJ, et al.: Hepatic allograft rescue following arterial thrombosis. Transplantation 1991, 15:86–90.CrossRefGoogle Scholar
  10. 10.
    Vorwerk D, Gunther RW, Klever P, et al.: Angioplasty and stent placement for treatment of hepatic artery thrombosis following liver transplantation. J Vasc Interv Radiol 1994, 5:309–314.PubMedCrossRefGoogle Scholar
  11. 11.
    Sanchez-Urdazpal L, Gores GJ, Ward EM, et al.: Ischemic-type biliary complications after orthotopic liver transplantation. Hepatology 1992, 16:49–53.PubMedCrossRefGoogle Scholar
  12. 12.
    Abou Ella KA, Al Sebayel MI, Ramirez CB, et al.: Hepatic artery thrombosis after orthotopic liver transplantation. Saudi Med J 2001, 22:211–214. A recent review of hepatic artery thrombosis with the aim to identify risk factors.Google Scholar
  13. 13.
    Lo C-M, Shaked A, Busuttil RW, et al.: Risk factors for liver transplantation across the ABO barrier. Transplantation 1994, 58:543–547.PubMedCrossRefGoogle Scholar
  14. 14.
    Campbell WL, Sheng R, Zajko AB, et al.: Intrahepatic biliary strictures after liver transplantation. Radiology 1994, 191:735–740.PubMedGoogle Scholar
  15. 15.
    Ludwig J, Batts KP, MacCarty RL: Ischemic cholangitis in hepatic allografts. Mayo Clin Proc 1992, 67:519–526.PubMedGoogle Scholar
  16. 16.
    Banzo I, Blanco I, Gutierrez-Mendiguchia C, et al.: Hepatobiliary scintigraphy for the diagnosis of bile leaks produced after T-tube removal in orthotopic liver transplantation. Nucl Med Common 1998, 19:229–236.CrossRefGoogle Scholar
  17. 17.
    Boraschi P, Braccini G, Gigoni R, et al.: Detection of biliary complications after orthotopic liver transplantation with MR cholangiography. Magn Reson Imaging 2001, 19:1097–1105. One of the first articles to demonstrate a role for MRCP when clinical suspicion of biliary complications may be low or when ERCP fails.PubMedCrossRefGoogle Scholar
  18. 18.
    Greif F, Bronsther OL, Van Thiel DH, et al.: The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg 1994, 219:40–45.PubMedCrossRefGoogle Scholar
  19. 19.
    Gomez R, Moreno E, Castellon C, et al.: Choledochocholedochostomy conversion to hepaticojejunostomy due to biliary obstruction in liver transplantation. World J Surg 2001, 25:1308–1312.PubMedCrossRefGoogle Scholar
  20. 20.
    Moser MA, Wall WJ: Management of biliary problems after liver transplantation. Liver Transpl 2001, 7(11 suppl 2):S46–52. A concise, up-to-date review of complications and management options.PubMedCrossRefGoogle Scholar
  21. 21.
    Testa G, Malago M, Broelsch CE: Complications of biliary tract in liver transplantation. World J Surg 2001, 25:1296–1299. A concise, recent review of biliary tract complications.PubMedCrossRefGoogle Scholar
  22. 22.
    Klein AS, Savader S, Burdick JF, et al.: Reduction of morbidity and mortality from biliary complications after liver transplantation. Am J Surg 1992, 163:519–524.CrossRefGoogle Scholar
  23. 23.
    Vitellas KM, El-Dieb A, Vaswani K, et al.: Detection of bile duct leaks using MR cholangiography with mangfodipir trisodium (Teslascan). J Comput Assist Tomogr 2000, 25:102–105.CrossRefGoogle Scholar
  24. 24.
    Sugimoto K, Kageoka M, Iwasaki H, et al.: A case of abscess formation in a remnant common bile duct after Roux-en-Y hepaticojejunostomy. Endoscopy 1999, 31:S30.PubMedGoogle Scholar
  25. 25.
    Chuang JH, Chen WJ, Lee SY, et al.: Prompt colonization of the hepaticojejunostomy and translocation of bacteria to liver after bile duct reconstruction. J Pediatr Surg 1998, 33:1215–1218.PubMedCrossRefGoogle Scholar
  26. 26.
    Colonna JO: Technical problems: biliary. In Transplantation of the Liver, edn 1. Edited by Busuttil R, Klintmalm G. Philadelphia: W B Saunders Co; 1996:617–625.Google Scholar
  27. 27.
    Kurzawinski TR, Selves L, Farouk M, et al.: Prospective study of hepatobiliary scintigraphy and endoscopic cholangiography for detection of early biliary complications after orthotopic liver transplantation. Br J Surg 1997, 84:620–623.PubMedCrossRefGoogle Scholar
  28. 28.
    Steiber AC, Ambrosino G, Kahn D, et al.: An unusual complication of choledochocholedochostomy in orthotopic liver transplantation. Transplant Proc 1988, 20:619–621.Google Scholar
  29. 29.
    Clavien PA, Camargo Ca, Baillie J, et al.: Sphincter of Oddi dysfunction after liver transplantation. Dig Dis Sci 1995, 40:73–74.PubMedCrossRefGoogle Scholar
  30. 30.
    Colonna JO, Shaked A, Gomex AS, et al.: Biliary strictures complicating liver transplantation. Ann Surg 1992, 216:344–350.PubMedCrossRefGoogle Scholar
  31. 31.
    Johnston TD, Gates R, Reddy KS, et al.: Nonoperative management of bile leaks following liver transplantation. Clin Transplant 2000, 14:365–369.PubMedCrossRefGoogle Scholar
  32. 32.
    Wolfsen HC, Porayko MK, Hughes RH, et al.: Role of endoscopic retrograde cholangiopancreatography after orthotopic liver transplantation. Transplantation 1992, 87:995–961.Google Scholar
  33. 33.
    Sherman S, Shaked A, Cryer HM, et al.: Endoscopic management of biliary fistulas complicating liver transplantation and other hepatobiliary operations. Ann Surg 1993, 218:167–175.PubMedCrossRefGoogle Scholar
  34. 34.
    Sugimoto K, Asari Y, Sakaguchi T, et al.: Endoscopic retrograde cholangiography in the nonsurgical management of blunt liver injury. J Trauma 1993, 35:192–199.PubMedGoogle Scholar
  35. 35.
    Kaplan SB, Zajko AB, Koneru B: Hepatic bilomas due to hepatic artery thrombosis in liver transplant recipients: percutaneous drainage and clinical outcome. Radiology 1990, 174:1031–1035.PubMedGoogle Scholar
  36. 36.
    Lake JR: Long-term management of biliary tract complications. Liver Transplant Surg 1995, 5:45–54.Google Scholar
  37. 37.
    Hintze RE, Adler A, Veltzke W, et al.: Endoscopic management of biliary complications after orthotopic liver transplantation. Hepatogastroenterology 1997, 44:258–262. An original article reporting that most biliary complications after liver transplantation can be treated endoscopically.PubMedGoogle Scholar
  38. 38.
    Rosen HR, Martin P: Liver transplantation. In Schiff’s Diseases of the Liver. Edited by Sorrell M, Maddrey W. Philadelphia: Lippincott-Raven; 1999:1589–1616.Google Scholar
  39. 39.
    Mosca S, Guiseppe M, Guardascione MA, et al.: Late biliary tract complications after orthotopic liver transplantation: diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography. J Gastroenterol Hepatol 2000, 15:654–660.PubMedCrossRefGoogle Scholar
  40. 40.
    Ward EM, Kiely MJ, Maus TP, et al.: Hilar biliary strictures after liver transplantation: cholangiography and percutaneous treatment. Radiology 1990, 177:259–263.PubMedGoogle Scholar
  41. 41.
    Cronin DC, Alonso JB, Piper KA, et al.: Biliary complications in living donor liver transplantation. Transplant Proc 1997, 29:419–490.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Sanjay Jagannath
    • 1
  • Anthony N. Kalloo
    • 1
  1. 1.Division of Gastroenterology, Department of MedicineThe Johns Hopkins HospitalBaltimoreUSA

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