Biliary Complications in Liver Transplantation

Biliary complications represent a leading cause of morbidity and graft loss following liver transplantation. These complications arise from leaks at the anastomosis, strictures due to scarring or ischaemic injury, and bile duct necrosis following vascular compromise. Anastomotic strictures typically present weeks to months post-transplant with cholestatic liver enzyme patterns, jaundice and cholangitis, while non-anastomotic strictures often signal hepatic artery thrombosis or small-duct injury and pose a greater challenge to endoscopic management. Leakages can occur at the bile duct anastomosis or T-tube sites, leading to bile collections and peritonitis if unrecognised. Diagnosis relies on a combination of laboratory tests, imaging modalities and invasive cholangiography procedures. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography enable both diagnosis and intervention, while refinements in bioengineered stents and endoluminal balloons offer potential improvements in patency and tissue integration. Early detection through ultrasonography and magnetic resonance cholangiopancreatography supports prompt intervention, thereby reducing the need for reoperation or retransplantation. Multidisciplinary care involving transplant surgeons, interventional radiologists and gastroenterologists remains central to optimising long-term outcomes and preserving graft function.

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Biliary Complications in Liver Transplantation publication trend

The graph below shows the total number of articles in biliary complications in liver transplantation across all publications each year (not limited to Nature Index journals).

Technical terms

Biliary stricture: A narrowing of the bile duct lumen, often causing cholestasis and recurrent cholangitis if untreated.

Anastomotic leak: Escape of bile from the surgical connection between donor and recipient bile ducts.

Endoscopic retrograde cholangiopancreatography (ERCP): A combined endoscopic and fluoroscopic technique to visualise and intervene on biliary pathology.

Percutaneous transhepatic cholangiography (PTC): Imaging and intervention on bile ducts via needle access through the liver parenchyma.

Biodegradable stent: A temporary scaffold that supports duct patency and gradually degrades without the need for retrieval.

References

1. Biosynthetic Plastics as Tunable Elastic and Visible Stent with Shape‐Memory to Treat Biliary Stricture. Advanced Science (2023).
2. Recent research progresses of bioengineered biliary stents. Materials Today Bio (2024).
3. BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION. ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) (2017).
4. Meta-Analysis of the Long Term Success Rate of Different Interventions in Benign Biliary Strictures. PLOS ONE (2017).
5. Diagnostic Value of Ultrasound in Detection of Biliary Tract Complications After Liver Transplantation. Hepatitis Monthly (2013).
6. Interventional radiology in the management of benign biliary stenoses, biliary leaks and fistulas: a pictorial review. Insights into Imaging (2012).