Biliary complications after liver transplantation: current perspectives and future strategies
Liver transplantation (LT) is a life-saving therapy for patients with end-stage liver disease and with acute liver failure, and it is associated with excellent outcomes and survival rates at 1 and 5 years. The incidence of biliary complications (BCs) after LT is reported to range from 5% to 20%, most of them occurring in the first three months, although they can occur also several years after transplantation. Among BCs, the most frequent are biliary leakage, bile duct anastomotic strictures (ASs), and non-anastomotic strictures (NAS). There is a wide heterogeneity regarding etiology; the main risk factors include surgical techniques, donor’s characteristics, and vascular alterations. The immunological side is unclear but the donor-specific alloantibodies (DSA) apparition could have a pathogenic implication. Therapeutic options include endoscopic retrograde cholangiopancreatography (ERCP), radiological percutaneous trans-hepatic biliary drainage (PTBD) or surgery. ERCP is the first-line treatment in most of cases, while PTBD is usually performed in patients with a Roux-en Y hepaticojejunostomy. Surgery is most frequently reserved to those patients who failed endoscopic or percutaneous approaches. The aim of this review is to summarize the available evidences on pathophysiology, risk factors, diagnosis and therapeutic management of BCs after LT.