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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 8, 2016; 8(10): 461-470
Published online Apr 8, 2016. doi: 10.4254/wjh.v8.i10.461
Management issues in post living donor liver transplant biliary strictures
Manav Wadhawan, Ajay Kumar
Manav Wadhawan, Ajay Kumar, Fortis Escorts Liver and Digestive Diseases Institute, Okhla, New Delhi 110025, India
Author contributions: Wadhawan M designed research, collected data, performed ERCP’s, analyzed data, and wrote paper; Kumar A designed research, performed ERCP’s and wrote paper.
Conflict-of-interest statement: There is no conflict of interest with anyone on the data published.
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: Ajay Kumar, MD, DM, MAMS, FRCP (Glasgow), Chief and Executive Director, Fortis Escorts Liver and Digestive Diseases Institute, Okhla, New Delhi 110025, India. ajaykge@hotmail.com
Received: May 14, 2015
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
Abstract

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.

Keywords: Living donor liver transplant; Biliary complications; Biliary strictures; Endoscopic retrograde cholangiopancreatography; Percutaneous transhepatic biliary drainage

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.