Published online Jul 18, 2015. doi: 10.4254/wjh.v7.i14.1856
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
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.
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.