Post-liver transplant biliary complications: Current knowledge and therapeutic advances

Table 1 Risk factors for the most common biliary complications

	Anastomotic	Non-anastomotic
Strictures	Advanced recipient age; Female donor; Failure to flush the donor duct; Preceding bile leakage; Acute rejection; Chronic rejection; Hepaticojejunostomy reconstruction	HAT; Chronic ductopenic rejection; Blood type ABO incompatibility; PSC, autoimmune hepatitis prolonged warm and cold ischemia times prolonged donor exposure to vasopressors
Leaks	Active bleeding at the bile duct end excessive dissection of periductal tissue tension on ductal anastomosis	T-tube tract, excessive use of electrocautery incorrect suture of the cystic duct stump
Stones and clots	Ischemia, stricture, infection
Biliary cast syndrome	Acute cellular rejection, bile stasis, ischemia, infection, sepsis, HAT
Haemobilia	Alcoholic liver disease, high body mass index of recipient; Iatrogenic: PTC, liver biopsy

PSC: Primary sclerosing cholangitis; PTC: Percutaneous; HAT: Hepatic artery thrombosis.

Table 2 Studies on the effectiveness of maximal stent therapy in post-operative biliary strictures

Ref.	Patients	Treatment duration	Mean number of stents	Number of ERCPs	Success rate
Costamagna et al[41], 2001	45	12.1 mo (range 2-24 mo)	3.2 (range 1-6)	4.1 (range 2-8)	89% (40/45)
Hsieh et at[23], 2012	41	5.3 (range 3.8-8.9)	7.0 (range 4-10)	4.0 (range 3.0-5.3)	100% (41/41)
Morelli et al[43], 2008	38	107 d (range 20-198 d)	2.5 (range 1-6)	3.4 (range 2-6)	87% (33/38)
Pasha et al[90], 2004	25	3.3 mo (range, 2.2-7 mo)	2.0 (range 1-4)	3.5 (range 1-9)	88% (22 of 25)
Tabibian et al[42], 2010	69	15 mo (range 12-60 mo)	3.0 (range 2-7)	2.5 (range 2-5)	94% (65/69)

ERCP: Endoscopic retrograde cholangiography.