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Biliary complications after deceased‐donor orthotopic liver transplantation
Author(s) -
Pascher Andreas,
Neuhaus Peter
Publication year - 2006
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-005-1083-z
Subject(s) - medicine , biliary sludge , liver transplantation , anastomosis , surgery , orthotopic liver transplantation , etiology , bile duct , broad spectrum , transplantation , gallbladder , chemistry , combinatorial chemistry
A wide range of potential biliary complications can occur after orthotopic liver transplantation (OLT). The most common biliary complications are bile leaks, anastomotic and intrahepatic strictures, stones, and ampullary dyfunction, which may occur in up to 20%–40% of OLT recipients. Leaks predominate in the early posttransplant period; stricture formation typically develops gradually over time. However, with the advent of new techniques, such as split‐liver, reduced‐size, and living‐donor liver transplantation, the spectrum of biliary complications has changed. Risk factors for biliary complications comprise technical failure; T‐tube or stent‐related complications; hepatic artery thrombosis; bleeding; ischemia/reperfusion injury; and other immunological, nonimmunological, and infectious complications. Noninvasive diagnostic methods have been established and treatment modalities have been modified towards a primarily nonoperative, endoscopy‐based strategy. Besides, the management of biliary complications after OLT requires a multidisciplinary approach, in which interventional and endoscopic treatment options have to be weighed up against surgical treatment options. The etiology and spectrum of bile duct complications, their diagnosis, and their treatment will be reviewed in this article.