Management of biliary complications after orthotopic liver transplantation: The role of endoscopy

Table 1 Risk factors for the development of biliary complications after OLT

1 T-tube

2 Roux-en-Y anastomosis

3 Ischemia/Reperfusion injury

4 Acute hepatic artery thrombosis

5 Infections

6 ABO mismatch

7 Non-heart beating donors

8 Primary sclerosis cholangitis

Table 2 Key points in the management of bile duct strictures

- Bile duct strictures can be classified as anastomotic or non-anastomotic

- Early anastomotic strictures usually respond to endoscopic dilation and short-term stenting

- Late anastomotic strictures have a high rate of recurrence (30%-40%) requiring long-term stenting (up to 24 mo).

- If endoscopic or percutaneous treatment fails, surgical repair or conversion to Roux-en-Y choledochojejunostomy may be necessary

- Non-anastomotic strictures require long-term stenting

- Some patients do not respond and finally undergo re-transplantation or die because of this complication