Biliary Leak Healing in Liver Transplants: What Makes a Difference?

Aims Biliary leaks are a well-recognized complication following liver transplantation (LT). Despite advancements in ERCP techniques, there remains variability in treatment success, Considering the peculiarities of this patient group, characterized by specific post-surgical anatomy, variations in endoductal pressure, and immunosuppressive therapy. This study was conducted to identify predictive factors influencing the healing of biliary leaks and the development of post-leak strictures, with the goal of refining management strategies and enhancing patient outcomes [1] [2].

Methods A retrospective analysis was performed on 34 LT patients who developed biliary leaks and were managed with ERCP within 24 hours from diagnosis. Variables included: the type of biliary stricture (anastomotic vs. non-anastomotic), presence of clinical symptoms (pain, fever, jaundice), time interval between multiple ERCPs to reach leak healing, characteristics of the stents (number, diameter in French, and length in cm), and leak parameters (high-flow vs. low-flow, early vs. late leak onset). Statistical analyses included Chi-square and Fisher's exact tests for categorical variables, while the Student's t-test and Mann-Whitney U test were used for continuous variables. The significance threshold was p<0.05.

Results The overall biliary leak healing rate was 94.1%. Early leaks (≤ 4 weeks) took significantly longer to heal (19.1 days) than late leaks (> 4 weeks) at 11 days. Pre-existing non-anastomotic strictures were significantly linked to lower healing rates. Clinical symptoms, including pain, fever, and jaundice, were associated with improved healing rates. An interval of less than one month between multiple ERCPs was linked to improved healing rates, while longer intervals reduced the likelihood of successful outcomes. The use of a higher number of stents was associated with longer healing times, while the use of stents with a larger diameter showed a correlation with shorter healing times. The Kehr tube was not found to be a factor associated with healing. Stricture formation post-leak was observed in 54.5% of patients, with a higher rate in those with early leaks (66.7%) compared to late leaks (50%). Patients undergoing multiple ERCPs had a greater likelihood of developing post-leak strictures.

Conclusions This study highlights key factors influencing biliary leak healing post-liver transplant, including pre-existing non-anastomotic strictures (NAS), stent characteristics (number and diameter), and leak timing. Specifically, larger stent diameters were associated with shorter healing times, while a higher number of stents correlated with prolonged recovery. These findings emphasize the importance of targeted stent selection—balancing the number and size of stents—to optimize healing outcomes and support the use of tailored ERCP strategies to improve management in liver transplant patients.

Publication History

Article published online:
27 March 2025

• References

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