Published online Apr 8, 2016. doi: 10.4254/wjh.v8.i10.461
Peer-review started: May 15, 2015
First decision: September 8, 2015
Revised: March 12, 2016
Accepted: March 22, 2016
Article in press: March 23, 2016
Published online: April 8, 2016
Processing time: 320 Days and 20.2 Hours
Biliary complications are common after living donor liver transplant (LDLT) although with advancements in surgical understanding and techniques, the incidence is decreasing. Biliary strictures are more common than leaks. Endoscopic retrograde cholangiopancreatography (ERCP) is the first line modality of treatment of post LDLT biliary strictures with a technical success rate of 75%-80%. Most of ERCP failures are successfully treated by percutaneous transhepatic biliary drainage (PTBD) and rendezvous technique. A minority of patients may require surgical correction. ERCP for these strictures is technically more challenging than routine as well post deceased donor strictures. Biliary strictures may increase the morbidity of a liver transplant recipient, but the mortality is similar to those with or without strictures. Post transplant strictures are short segment and soft, requiring only a few session of ERCP before complete dilatation. Long-term outcome of patients with biliary stricture is similar to those without stricture. With the introduction of new generation cholangioscopes, ERCP success rate may increase, obviating the need for PTBD and surgery in these patients.
Core tip: Biliary complications are the Achilles heel of liver transplantation and are more common in live related liver transplant than cadaver liver transplant. Endoscopic retrograde cholangiopancreatography along ith percutaneous transhepatic biliary drainage is successful in managing more than 90% of biliary complications after liver transplant. Although strictures increase morbidity after liver transplant, the mortality rates are not influenced by biliary strictures. This review provides diagnostic approach and management algoritham of these biliary structures in the setting of right lobe liver transplant.