Biliary Complications After Liver Transplantation

Liver transplantation continues to be an optimal treatment choice for end-stage liver disease, acute liver failure, and primary liver cancer. An understanding and anticipation of potential complications of liver transplantation is integral to the medical and interventional management of these postoperative patients. Complications related to the biliary system are the most common posttransplant complications. Potential complications include biliary strictures, leakage, intraductal stone/sludge, and biliary cast syndrome. Multiple diagnostic imaging modalities are available including ultrasound, CT angiography, and hepatobiliary iminodiacetic acid scanning for evaluation of the biliary system and associated complications. The approach of interventional access to the biliary system after surgery is tailored based on surgical transplantation techniques. Endoscopic retrograde cholangiopancreatography remains the imaging modality of choice for evaluation and potential therapeutic intervention. If the biliary tree is not accessible by endoscopy due to postsurgical anatomy changes, interventional radiology may play a vital role in complication management and can provide percutaneous transhepatic cholangiography as a less invasive alternative to surgical intervention.