Table 1

Biliary complications following orthotopic liver transplantation

ComplicationPresentationIncidenceTime to presentationRisk factorsManagement
Anastomotic strictures

  • Abdominal pain.

  • Jaundice.

  • Cholestatic liver injury.

  • Asymptomatic.

  • 6.6%–12.3%.

  • Early to late.

  • Ischaemia.

  • Genetic factors.

  • Infection.

  • ERCP with balloon dilatation or stenting.

Non-anastomotic strictures

  • Abdominal pain.

  • Jaundice.

  • Cholestatic liver injury.

  • Asymptomatic.

  • 10%–16%.

  • Late.

  • Ischaemia.

  • Genetic factors.

  • Infection.

  • Rejection.

  • ERCP with balloon dilatation or stenting.

  • Retransplant.

Bile leak

  • Liver injury.

  • Fever.

  • Bilious drainage (if drain in place).

  • 7.1%–11.8%.

  • Early to late.

  • Ischaemia.

  • T-tube placement.

  • Iatrogenic.

  • ERCP with sphincterotomy or stenting.

  • Percutaneous drainage.

Vanishing bile duct

  • Jaundice.

  • Abdominal pain.

  • Fatigue.

  • Low (minimal data currently present).

  • Early to late.

  • Rejection.

  • Infection.

  • Retransplant.

  • Spontaneous resolution (quite rare).

Bile duct filling defects

  • Jaundice

  • Cholestatic liver injury.

  • Abdominal pain.

  • 3%–6%.

  • Early to late.

  • Ischaemia.

  • Infection.

  • Rejection.

  • ERCP with stenting.

  • EUS drainage.

Sphincter of Oddi stenosis

  • Cholestatic liver injury.

  • Abdominal pain.

  • 2%–3.5%.

  • Early to late.

  • Ischaemia.

  • ERCP with sphincterotomy.

  • ERCP, endoscopic retrograde cholangiopancreatography; EUS, endoscopic ultrasound.