Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation

Background: Percutaneous transhepatic radiologic procedures as well as ERCP-based techniques have been used to treat biliary complications after liver transplantation. However, the efficacy of these treatments has not yet been clarified, especially for complications occurring after living donor liver transplantation. Methods: A retrospective study was performed to determine the frequency and types of the biliary complications after cadaveric donor liver transplantation and living donor liver transplantation. The success of ERCP and percutaneous transhepatic radiologic procedures was also evaluated. The choice of treatment approach, ERCP or percutaneous transhepatic radiologic procedures, depended on the type of biliary reconstruction and accessibility of the lesion. Results: Among 429 adult patients who underwent liver transplantation, 39 biliary complications developed in 25 patients (5.8%): biliary stricture (20), biliary stones (10), and bile leak (9). The frequency of biliary complications (5.8%; 6/103) after cadaveric donor liver transplantation was not significantly different compared with that after living donor liver transplantation (5.8%; 19/326). Success rates for treatment of biliary complications by means of ERCP and percutaneous transhepatic radiologic procedures were, respectively, 100% (11/11) and 78% (18/23). For endoscopically treated patients, balloon dilation alone for biliary strictures and nasobiliary tube placement alone for bile leaks resulted in complete resolution of the complication in, respectively, 67% (2/3) and 40% (2/5) without further intervention. Conclusions: Transpapillary endoscopic and percutaneous transhepatic radiologic interventions are both effective therapies for biliary complications associated with liver transplantation. They are complementary approaches that help to avoid surgery for these complications. (Gastrointest Endosc 2003;57:78-85.)