Treatment of Benign Biliary Strictures after Liver Transplantation

Treatment of Benign Biliary Strictures after Liver Transplantation The most frequent biliary complications after liver transplantation are strictures, bile leaks and bile duct stones. The incidence ranges between 10 and 25%. Risk factors for the development of biliary complications are technical factors during surgery, hepatic artery thrombosis, prolonged cold and warm ischemia or pre-orthotopic liver transplantation diagnosis of CMV infection. If there is a clinical suspicion, a cholangiogram should be obtained. Although magnetic resonance cholangiopancreatography has gained increasing acceptance as a reliable technique, endoscopic retrograde cholangiopancreatography (ERCP) remain the gold standard. Percutaneous transhepatic cholangiography should be reserved for patients with Roux-en-Y choledochojejunostomy in whom ERCP via single-ballon enteroscopy was unsuccessful. Most of bile leaks can be resolved non-operatively with early endoscopic intervention. Among biliary strictures, best success rates can be achieved in anastomotic strictures. In our opinion balloon dilation alone is superior to the approach using multiple plastic stents. The outcome in non-anastomotic strictures is not as favorable as in anastomotic strictures. Most patients with diffuse strictures require re-transplantation