Biliary Complications After Liver Transplantation

  • Jörg G. AlbertEmail author


Biliary complications are considered the Achilles’ heel of orthotopic liver transplantation and significantly influence the outcome of the patient. Ischemia, rejection of the donor tissue, and recurring underlying disease contribute to the etiology of biliary complications. Biliary strictures constitute 40–60% of biliary complications after liver transplantation. They are more common after living donor–related liver transplantation (LDLT) than orthotopic liver transplantation (OLT). Thereby, anastomotic biliary stricture (ABS) needs differentiation from non-anastomotic stricture (NAS), such as ischemic-type biliary lesions (ITBL) that occur within the intrahepatic and proximal bile ducts.

Multiple plastic stent insertion, in some centers following hydrostatic balloon dilation, will achieve stricture resolution in a high rate of over 80% of choledocho-choledochal ABS in OLT patients. Success rate of endoscopic treatment of ABSs after LDLT may be less successful because of the small size of the ABSs, their multiple number, and peripheral localization. Balloon dilation followed by multiple plastic stent insertion may achieve a mean resolution rate of about 50%. Percutaneous transhepatic biliary drainage is rarely required in complex cases when endoscopic therapy failed.


Orthotopic liver transplantation Bile leak Bile duct stricture Stenting Self-expanding metal stent Plastic stent 



Anastomotic biliary stricture


Common bile duct






(Fully) Covered self-expanding metal stent


Endoscopic retrograde cholangiopancreatography


Hepatic artery thrombosis


Ischemic-type biliary lesion


Living donor liver transplantation


Multiple plastic stents


Magnetic resonance cholangiopancreatography


Non-anastomotic stricture


Non-expanding plastic stent


Orthotopic liver transplantation


Primary sclerosing cholangitis


Percutaneous transhepatic cholangiodrainage


Self-expanding metal stent


Cholangiopathy of the critically ill patient


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Abteilung für Gastroenterologie, Hepatologie und EndokrinologieRobert-Bosch-KrankenhausAuerbachstraßeGermany

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