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World J Hepatol. Jul 18, 2015; 7(14): 1856-1865
Published online Jul 18, 2015. doi: 10.4254/wjh.v7.i14.1856
Spectrum of biliary complications following live donor liver transplantation
Priya Simoes, Varun Kesar, Jawad Ahmad
Priya Simoes, Varun Kesar, Jawad Ahmad, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Author contributions: Simoes P made the substantial contribution to manuscript design and manuscript writing; Kesar V contributed to writing the manuscript; Ahmad J conceptualized and designed manuscript drafted and critically revised the manuscript and approved the final version.
Conflict-of-interest statement: No conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jawad Ahmad, MD, FRCP, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029, United States. javbob@hotmail.com
Telephone: +1-212-2418035 Fax: +1-212-7317340
Received: October 7, 2014
Peer-review started: October 20, 2014
First decision: December 17, 2014
Revised: January 22, 2015
Accepted: July 7, 2015
Article in press: July 8, 2015
Published online: July 18, 2015
Processing time: 290 Days and 15.9 Hours
Abstract

Liver transplantation is the optimal treatment for many patients with advanced liver disease, including decompensated cirrhosis, hepatocellular carcinoma and acute liver failure. Organ shortage is the main determinant of death on the waiting list and hence living donor liver transplantation (LDLT) assumes importance. Biliary complications are the most common post operative morbidity after LDLT and occur due to anatomical and technical reasons. They include biliary leaks, strictures and cast formation and occur in the recipient as well as the donor. The types of biliary complications after LDLT along with their etiology, presenting features, diagnosis and endoscopic and surgical management are discussed.

Keywords: Liver transplantation; Biliary stricture; Bile leak

Core tip: Living donor liver transplantation (LDLT) is associated with increased risk of post transplant biliary complications in recipients and donors, namely bile leaks and biliary strictures. Large bile leaks present early after LDLT and are treated with endoscopic stenting. Ischemic injury to cholangiocytes is the main cause of stricture formation. These may present early or late and are managed with endoscopic dilation followed by stent placement. Occasionally, surgical repair may be required. Cast formation may complicate biliary strictures, requiring endocopic extraction and frequent replacement of stents with cleaning of biliary sludge and debris.