Biliary strictures in the liver transplant patient

• Published in: Techniques in gastrointestinal endoscopy 2016-04, Vol.18 (2), p.91-97
• Main Author: Sharzehi, Kaveh, MD, MS
• Format: Article
• Language: English
• Subjects: biliary strictures; diagnosis; ERCP; Gastroenterology and Hepatology; liver transplant; management; stent placement
• ISSN: 1096-2883; 1558-5050
• DOI: 10.1016/j.tgie.2016.06.002

Biliary complications are the most common adverse events following liver transplantation (LT). Living donor liver transplantation have a higher rate of biliary complications compared to deceased donor liver transplantation. Multiple risk factors have been implicated in the development of biliary strictures, which could be categorized into recipient, graft, operative factors and post-operative factors. Bile duct strictures following liver transplantation are classified as anastomotic strictures (BAS) or non-anastomotic strictures (NAS). NAS have a less favorable response to endoscopic management. Magnetic resonance cholangiopancreatography is the first-choice examination when a biliary complication is suspected following LT. For treating BAS, ERCP directed balloon dilatation complemented with the placement of multiple plastic stents (MPS) has become the standard of care and results in stricture resolution in over 90% of cases. Temporary placement of fully covered self-expanding metal stents (FCSEMSs) has not been demonstrated to be superior mostly because of the high migration rate of current FCSEMSs models. FCSEMS with special anti-migratory design may be superior and cost effective compared to MPS, but need evaluation in prospective and randomized trials.