Download PDF
Endoscopy 2005; 37(9): 857-863
DOI: 10.1055/s-2005-870192
The Expert Approach Section
© Georg Thieme Verlag KG Stuttgart · New York

Biliary Complications after Liver Transplantation: the Role of Endoscopy

P.  J.  Thuluvath1 , P.  R.  Pfau2 , M.  B.  Kimmey3 , G.  G.  Ginsberg4
  • 1Dept. of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
  • 2Dept. of Medicine, University of Wisconsin Medical School, Madison, Wisconsin, USA
  • 3University of Washington Medical Center, Seattle, Washington, USA
  • 4Division of Gastroenterology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
Further Information

Publication History

Publication Date:
22 August 2005 (online)

Also available at
    Permissions and Reprints

Abstract

Biliary complications are important causes of early and late postoperative morbidity and mortality after liver transplantation and are seen in 10 - 20 % of the patients. The common biliary complications include bile leaks, stones or debris, and anastomotic strictures. Less common complications are hilar strictures, intrahepatic strictures, and papillary stenosis/dysfunction. The complications are similar in living-donor and cadaveric liver transplantations, except for a higher incidence of bile leaks among living-donor transplant recipients. The clinical presentation of post-liver transplant bile duct complications is often subtle, and noninvasive imaging studies may sometimes fail to detect mild but clinically significant stenoses or small leaks. Early recognition and prompt treatment of biliary complications following liver transplantation reduces the morbidity and improves long-term graft and patient survival. In this report, we discuss the role of endoscopy in the diagnosis, treatment options, and the outcome for patients with biliary complications following liver transplantation.

References

  • 1 Stratta R J, Wood R P, Langnas A N. et al . Diagnosis and treatment of biliary tract complications after orthotopic liver transplantation.  Surgery. 1989;  106 675-683
    Google Scholar
  • 2 Greif F, Bronsther O L, Van Thiel D H. et al . The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation.  Ann Surg. 1994;  219 40-45
    CrossrefPubMedGoogle Scholar
  • 3 Pfau P R, Kochman M L, Lewis J D. et al . Endoscopic management of postoperative complications in orthotopic liver transplantation.  Gastrointest Endosc. 2000;  52 55-65
    CrossrefPubMedGoogle Scholar
  • 4 Thuluvath P J, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation.  Liver Int. 2003;  23 156-162
    CrossrefPubMedGoogle Scholar
  • 5 Zajko A B, Campbell W L, Logsdon G A. et al . Cholangiographic findings in hepatic artery occlusion after liver transplantation.  AJR Am J Roentgenol. 1987;  149 485-489
    Google Scholar
  • 6 Sanchez-Urdazpal L, Gores G J, Ward E M. et al . Diagnostic features and clinical outcome of ischemic-type biliary complications after liver transplantation.  Hepatology. 1993;  17 605-609
    PubMedGoogle Scholar
  • 7 Douzdjian V, Abecassis M M, Johlin F C. Sphincter of Oddi dysfunction following liver transplantation: screening by bedside manometry and definitive manometric evaluation.  Dig Dis Sci. 1994;  39 253-255
    PubMedGoogle Scholar
  • 8 Richards R D, Yeaton P, Shaffer H A. et al . Human sphincter of Oddi and cholecystokinin response following liver transplantation.  Dig Dis Sci. 1993;  38 462-468
    CrossrefPubMedGoogle Scholar
  • 9 Tepetes K, Karavias D, Felekouras E. et al . Bile leakage following T-tube removal in orthotopic liver transplantation.  Hepatogastroenterology. 1999;  46 425-427
    PubMedGoogle Scholar
  • 10 Scatton O, Meunier B, Cherqui D. et al . Randomized trial of choledochocholedochostomy with or without T tube after orthotopic liver transplantation.  Ann Surg. 2001;  233 432-437
    CrossrefPubMedGoogle Scholar
  • 11 Randall H B, Wachs M E, Somberg K A. et al . The use of the T tube after orthotopic liver transplantation.  Transplantation. 1996;  61 258-261
    PubMedGoogle Scholar
  • 12 Johnson M W, Thompson P, Meehan A. et al . Internal biliary stenting in orthotopic liver transplantation.  Liver Transpl. 2000;  6 356-361
    CrossrefPubMedGoogle Scholar
  • 13 Boraschi P, Braccini G, Gigoni R. et al . Detection of biliary complications after orthotopic liver transplantation with MR cholangiography.  Magn Reson Imaging. 2001;  19 1097-1105
    CrossrefPubMedGoogle Scholar
  • 14 Kuo P C, Lewis W D, Stokes K. et al . A comparison of operation, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography in biliary complications after hepatic transplantation.  J Am Coll Surg. 1994;  179 177-181
    PubMedGoogle Scholar
  • 15 Davidson B R, Rai R, Nandy A. et al . Results of choledochojejunostomy in the treatment of biliary complications after liver transplantation in the era of nonsurgical therapies.  Liver Transpl. 2000;  6 201-206
    PubMedGoogle Scholar
  • 16 Porayko M K, Kondo M, Steers J L. Liver transplantation: late complications of the biliary tract and their management.  Semin Liver Dis. 1995;  15 139-155
    PubMedGoogle Scholar
  • 17 Rizk R S, McVicar J P, Emond M J. et al . Endoscopic management of biliary strictures in liver transplant recipients: effect on patient and graft survival.  Gastrointest Endosc. 1998;  47 128-135
    CrossrefPubMedGoogle Scholar
  • 18 Bourgeois N, Devière J, Yeaton P. et al . Diagnostic and therapeutic endoscopic retrograde cholangiography after liver transplantation.  Gastrointest Endosc. 1995;  42 527-534
    CrossrefPubMedGoogle Scholar
  • 19 Mahajani R V, Cotler S J, Uzer M F. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation.  Endoscopy. 2000;  32 943-949
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Theilmann L, Kuppers B, Kadmon M. et al . Biliary tract strictures after orthotopic liver transplantation: diagnosis and management.  Endoscopy. 1994;  26 517-522
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Gomez R, Moreno E, Castellon C. et al . Choledochocholedochostomy conversion to hepaticojejunostomy due to biliary obstruction in liver transplantation.  World J Surg. 2001;  25 1308-1312
    CrossrefPubMedGoogle Scholar
  • 22 Abbasoglu O, Levy M F, Vodapally M S. et al . Hepatic artery stenosis after liver transplantation: incidence, presentation, treatment, and long term outcome.  Transplantation. 1997;  63 250-255
    CrossrefPubMedGoogle Scholar
  • 23 Sachez-Urdazpal L, Gores G J, Ward E M. et al . Ischemic-type biliary complications after orthotopic liver transplantation.  Hepatology. 1992;  16 49-53
    CrossrefPubMedGoogle Scholar
  • 24 Ostroff J W, Roberts J P, Gordon R L. et al . The management of T tube leaks in orthotopic liver transplant recipients with endoscopically placed nasobiliary catheters.  Transplantation. 1990;  49 922-924
    PubMedGoogle Scholar
  • 25 Sherman S, Shaked A, Cryer H M. et al . Endoscopic management of biliary fistulas complicating liver transplantation and other hepatobiliary operations.  Ann Surg. 1993;  218 167-175
    CrossrefPubMedGoogle Scholar
  • 26 Saab S, Martin P, Soliman G Y. et al . Endoscopic management of biliary leaks after T-tube removal in liver transplant recipients: nasobiliary drainage versus biliary stenting.  Liver Transpl. 2000;  6 627-632
    CrossrefPubMedGoogle Scholar
  • 27 Testa G, Malago M, Broelsch C E. Complications of biliary tract in liver transplantation.  World J Surg. 2001;  25 1296-1299
    CrossrefPubMedGoogle Scholar
  • 28 Heffron T G, Pillen T, Welch D. et al . Biliary complications after pediatric liver transplantation revisited.  Transplant Proc.. 2003;  35 1461-1462
    CrossrefPubMedGoogle Scholar
  • 29 Shah J N, Ahmad N A, Shetty K. et al . Endoscopic management of biliary complications after adult living donor liver transplantation.  Am J Gastroenterol. 2004;  99 1291-1295
    CrossrefPubMedGoogle Scholar
  • 30 Ward E M, Kiely M J, Maus T P. et al . Hilar biliary strictures after liver transplantation: cholangiography and percutaneous treatment.  Radiology. 1990;  177 259-263
    PubMedGoogle Scholar
  • 31 Shah J N, Haigh W G, Lee S P. et al . Biliary casts after orthotopic liver transplantation: clinical factors, treatment, biochemical analysis.  Am J Gastroenterol. 2003;  98 1861-1867
    CrossrefPubMedGoogle Scholar
  • 32 Steiber A C, Ambrosino G, Kahn D. et al . An unusual complication of choledochocholedochostomy in orthotopic liver transplantation.  Transplant Proc. 1988;  20 619-621
    PubMedGoogle Scholar
  • 33 Fondevila C, Ghobrial R M, Fuster J. et al . Biliary complications after adult living donor liver transplantation.  Transplant Proc. 2003;  35 1902-1903
    CrossrefPubMedGoogle Scholar
  • 34 Egawa H, Inomata Y, Uemoto S. et al . Biliary anastomotic complications in 400 living related liver transplantations.  World J Surg. 2001;  25 1300-1307
    CrossrefPubMedGoogle Scholar
  • 35 Gondolesi G E, Varotti G, Florman S S. et al . Biliary complications in 96 consecutive right lobe living donor transplant recipients.  Transplantation. 2004;  77 1842-1848
    CrossrefPubMedGoogle Scholar
  • 36 Ito T, Kiuchi T, Egawa H. et al . Surgery related morbidity in living donors of right lobe liver graft: lesions from the first 200 cases.  Transplantation. 2003;  76 158-163
    PubMedGoogle Scholar
  • 37 Lo C M. Complications and long-term outcome of living liver donors: a survey of 1,508 cases in five Asian centers.  Transplantation. 2003;  75 (3 Suppl) S12-S15
    PubMedGoogle Scholar
  • 38 Malago M, Testa G, Frilling A. et al . Right living donor liver transplantation: an option for adult patients.  Ann Surg. 2003;  238 853-863
    PubMedGoogle Scholar
  • 39 Hisatsune H, Yazumi S, Egawa H. et al . Endoscopic management of biliary strictures after duct to duct biliary reconstruction in right lobe living donor liver transplantation.  Transplantation. 2003;  76 810-815
    PubMedGoogle Scholar

P. J. Thuluvath, M.D., F.R.C.P.

The Johns Hopkins University School of Medicine

1830 East Monument Street · Baltimore, MD 21205 · USA

Fax: +1-410-614-9612

Email: pjthuluv@jhmi.edu

      >