Biliary Complications

Biliary complications were defined by Sir Roy Calne as the “Achilles heel” of liver transplantation. These complications occur in 10-30% of the patients following liver transplantation, and vary in several reports from 0% to 28% in pediatric split liver transplantation &, and from 10% to 38% in pediatric living related liver transplantation &. Biliary complications may occur with different clinical manifestations and more frequently in association with several conditions . Several techniques and procedures have been developed to diagnose and treat biliary complication.
The overall incidence of biliary complication in our series was 26%. This complication developed mainly in patients who received a split liver (20/72) or a reduced liver (4/8), compared to the whole liver recipients (1/28). Biliary complications consisted of anastomotic stricture (n=10), anastomotic leak (n=4) or cut-edge leak (n=11). Stenoses were successfully treated in all but one case with percutaneous transhepatic colangiography, balloon dilatation and stenting. One patient required revision of the anastomosis. Cut-edge leaks were treated with percutaneous drainage in 9 cases and with surgical revision in two cases. Anastomotic leaks always required surgical intervention on the anastomosis. A 10-month old boy, transplanted with a left lateral segment for extrahepatic biliary atresia, developed progressive intrahepatic biliary tree distension three months after transplant. Transhepatic cholangiography revealed a patent hepaticojejunostomy, with an intestinal stricture a few centimeters below the bilioenterostomy, where an intestinal valve had been created at the time of Kasai portoenterostomy. The child underwent laparotomy with resection of the intestinal loop and revision of the hepaticojejunostomy. No biliary complications directly resulted in graft or patient loss.