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Digestive Disease Interventions 2018; 02(03): 244-248
DOI: 10.1055/s-0038-1667343
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ischemic Complications after Liver Transplantation

Christopher R. Ingraham
1   Department of Radiology, University of Washington, Seattle
,
Martin I. Montenovo
2   Division of Transplant Surgery, University of Washington, Seattle
› Author Affiliations
Further Information

Publication History

12 June 2018

28 June 2018

Publication Date:
20 August 2018 (online)

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Abstract

Despite major advances in the field of liver transplantation over the past few decades with both increased graft and patient survival, biliary complications still occur in many patients after liver transplantation. Complications can range from a biliary leak or biloma to strictures most commonly involving the surgical anastomosis, or elsewhere in the biliary tree. Etiologies of these complications include surgical technique, rejection, complications secondary to infection, and vascular complications causing ischemia of the bile ducts. Biliary complications, particularly biliary ischemia, can cause significant morbidity to the patient, and may require multiple endoscopic, endovascular, or percutaneous therapies for successful treatment, or even retransplantation in severe cases. This review will provide an overview of common biliary complications with a focus on biliary ischemia.

Keywords

biliary ischemia - liver transplantation - biliary stricture - percutaneous biliary drainage - hepatic artery stenosis - hepatic artery thrombosis
 

  • References

  • 1 Buck DG, Zajko AB. Biliary complications after orthotopic liver transplantation. Tech Vasc Interv Radiol 2008; 11 (01) 51-59
    CrossrefPubMedSearch in Google Scholar
  • 2 Seehofer D, Eurich D, Veltzke-Schlieker W, Neuhaus P. Biliary complications after liver transplantation: old problems and new challenges. Am J Transplant 2013; 13 (02) 253-265
    CrossrefPubMedSearch in Google Scholar
  • 3 Verdonk RC, Buis CI, Porte RJ, Haagsma EB. Biliary complications after liver transplantation: a review. Scand J Gastroenterol Suppl 2006; (243) 89-101
    PubMedSearch in Google Scholar
  • 4 Akamatsu N, Sugawara Y, Hashimoto D. Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: a systematic review of the incidence, risk factors and outcome. Transpl Int 2011; 24 (04) 379-392
    CrossrefPubMedSearch in Google Scholar
  • 5 Ingraham CR, Montenovo M. Interventional and surgical techniques in solid organ transplantation. Radiol Clin North Am 2016; 54 (02) 267-280
    CrossrefPubMedSearch in Google Scholar
  • 6 Wojcicki M, Milkiewicz P, Silva M. Biliary tract complications after liver transplantation: a review. Dig Surg 2008; 25 (04) 245-257
    CrossrefPubMedSearch in Google Scholar
  • 7 Ferraz-Neto BH, Meira-Filho SR, Hidalgo R. , et al. Correlation between graft arterial anatomy and biliary complications after liver transplantation. Transplant Proc 2007; 39 (08) 2514-2515
    CrossrefPubMedSearch in Google Scholar
  • 8 Soin AS, Friend PJ, Rasmussen A. , et al. Donor arterial variations in liver transplantation: management and outcome of 527 consecutive grafts. Br J Surg 1996; 83 (05) 637-641
    CrossrefPubMedSearch in Google Scholar
  • 9 Dodd III GD, Memel DS, Zajko AB, Baron RL, Santaguida LA. Hepatic artery stenosis and thrombosis in transplant recipients: Doppler diagnosis with resistive index and systolic acceleration time. Radiology 1994; 192 (03) 657-661
    CrossrefPubMedSearch in Google Scholar
  • 10 Vit A, De Candia A, Como G, Del Frate C, Marzio A, Bazzocchi M. Doppler evaluation of arterial complications of adult orthotopic liver transplantation. J Clin Ultrasound 2003; 31 (07) 339-345
    CrossrefPubMedSearch in Google Scholar
  • 11 Gastaca M. Extended criteria donors in liver transplantation: adapting donor quality and recipient. Transplant Proc 2009; 41 (03) 975-979
    CrossrefPubMedSearch in Google Scholar
  • 12 Jagannath S, Kalloo AN. Biliary complications after liver transplantation. Curr Treat Options Gastroenterol 2002; 5 (02) 101-112
    CrossrefPubMedSearch in Google Scholar
  • 13 Verdonk RC, Buis CI, Porte RJ. , et al. Anastomotic biliary strictures after liver transplantation: causes and consequences. Liver Transpl 2006; 12 (05) 726-735
    CrossrefPubMedSearch in Google Scholar
  • 14 Woolf GM, Vierling JM. Disappearing intrahepatic bile ducts: the syndromes and their mechanisms. Semin Liver Dis 1993; 13 (03) 261-275
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Op den Dries S, Sutton ME, Lisman T, Porte RJ. Protection of bile ducts in liver transplantation: looking beyond ischemia. Transplantation 2011; 92 (04) 373-379
    CrossrefPubMedSearch in Google Scholar
  • 16 Buis CI, Hoekstra H, Verdonk RC, Porte RJ. Causes and consequences of ischemic-type biliary lesions after liver transplantation. J Hepatobiliary Pancreat Surg 2006; 13 (06) 517-524
    CrossrefPubMedSearch in Google Scholar
  • 17 Sanchez-Urdazpal L, Gores GJ, Ward EM. , et al. Ischemic-type biliary complications after orthotopic liver transplantation. Hepatology 1992; 16 (01) 49-53
    CrossrefPubMedSearch in Google Scholar
  • 18 Buis CI, Verdonk RC, Van der Jagt EJ. , et al. Nonanastomotic biliary strictures after liver transplantation, part 1: radiological features and risk factors for early vs. late presentation. Liver Transpl 2007; 13 (05) 708-718
    CrossrefPubMedSearch in Google Scholar
  • 19 van der Hilst CS, Ijtsma AJ, Bottema JT. , et al. The price of donation after cardiac death in liver transplantation: a prospective cost-effectiveness study. Transpl Int 2013; 26 (04) 411-418
    CrossrefPubMedSearch in Google Scholar
  • 20 Stange BJ, Glanemann M, Nuessler NC, Settmacher U, Steinmüller T, Neuhaus P. Hepatic artery thrombosis after adult liver transplantation. Liver Transpl 2003; 9 (06) 612-620
    CrossrefPubMedSearch in Google Scholar
  • 21 Noack K, Bronk SF, Kato A, Gores GJ. The greater vulnerability of bile duct cells to reoxygenation injury than to anoxia. Implications for the pathogenesis of biliary strictures after liver transplantation. Transplantation 1993; 56 (03) 495-500
    CrossrefPubMedSearch in Google Scholar
  • 22 Abt P, Crawford M, Desai N, Markmann J, Olthoff K, Shaked A. Liver transplantation from controlled non-heart-beating donors: an increased incidence of biliary complications. Transplantation 2003; 75 (10) 1659-1663
    CrossrefPubMedSearch in Google Scholar
  • 23 Dubbeld J, Hoekstra H, Farid W. , et al. Similar liver transplantation survival with selected cardiac death donors and brain death donors. Br J Surg 2010; 97 (05) 744-753
    CrossrefPubMedSearch in Google Scholar
  • 24 García-Valdecasas JC, Tabet J, Valero R. , et al. Evaluation of ischemic injury during liver procurement from non-heart-beating donors. Eur Surg Res 1999; 31 (06) 447-456
    CrossrefPubMedSearch in Google Scholar
  • 25 Duffy JP, Hong JC, Farmer DG. , et al. Vascular complications of orthotopic liver transplantation: experience in more than 4,200 patients. J Am Coll Surg 2009; 208 (05) 896-903 , discussion 903–905
    CrossrefPubMedSearch in Google Scholar
  • 26 Kogut MJ, Shin DS, Padia SA, Johnson GE, Hippe DS, Valji K. Intra-arterial thrombolysis for hepatic artery thrombosis following liver transplantation. J Vasc Interv Radiol 2015; 26 (09) 1317-1322
    CrossrefPubMedSearch in Google Scholar
  • 27 Saad WE. Management of hepatic artery steno-occlusive complications after liver transplantation. Tech Vasc Interv Radiol 2007; 10 (03) 207-220
    CrossrefPubMedSearch in Google Scholar
  • 28 Saad WE, Davies MG, Sahler L. , et al. Hepatic artery stenosis in liver transplant recipients: primary treatment with percutaneous transluminal angioplasty. J Vasc Interv Radiol 2005; 16 (06) 795-805
    CrossrefPubMedSearch in Google Scholar
  • 29 Ueno T, Jones G, Martin A. , et al. Clinical outcomes from hepatic artery stenting in liver transplantation. Liver Transpl 2006; 12 (03) 422-427
    CrossrefPubMedSearch in Google Scholar
  • 30 Shao H, Arellano R. Percutaneous management of benign and postoperative biliary strictures. Dig Dis Interv 2017; 1: 28-35
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Fernández-Simon A, Díaz-Gonzalez A, Thuluvath PJ, Cárdenas A. Endoscopic retrograde cholangiography for biliary anastomotic strictures after liver transplantation. Clin Liver Dis 2014; 18 (04) 913-926
    CrossrefPubMedSearch in Google Scholar
  • 32 Atwal T, Pastrana M, Sandhu B. Post-liver transplant biliary complications. J Clin Exp Hepatol 2012; 2 (01) 81-85
    CrossrefPubMedSearch in Google Scholar
  • 33 Kothary N, Patel AA, Shlansky-Goldberg RD. Interventional radiology: management of biliary complications of liver transplantation. Semin Intervent Radiol 2004; 21 (04) 297-308
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 DePietro DM, Shlansky-Goldberg RD, Soulen MC. , et al. Long-term outcomes of a benign biliary stricture protocol. J Vasc Interv Radiol 2015; 26 (07) 1032-1039
    CrossrefPubMedSearch in Google Scholar
  • 35 Gwon DI, Ko GY, Ko HK, Yoon HK, Sung KB. Percutaneous transhepatic treatment using retrievable covered stents in patients with benign biliary strictures: mid-term outcomes in 68 patients. Dig Dis Sci 2013; 58 (11) 3270-3279
    CrossrefPubMedSearch in Google Scholar
  • 36 Gwon DI, Ko GY, Sung KB, Kim JH, Yoon HK. Percutaneous transhepatic treatment of postoperative bile leaks: prospective evaluation of retrievable covered stent. J Vasc Interv Radiol 2011; 22 (01) 75-83
    CrossrefPubMedSearch in Google Scholar