Management of Post Liver Transplant Biliary Strictures

Management of Post Liver Transplant Biliary Strictures

Endoscopic Interventions

  • Biliary anastomosis has long been considered the Achilles heel of orthotopic liver transplantation (OLT).
  • Biliary strictures are the most frequently described complication, affecting 4% to 15% of patients after liver transplant.
  • It can be anastomotic (85%) or nonanastomotic.
  • Anastomotic strictures appear more often in living donor liver transplantation (LDLT) than in deceased donor liver transplant (DDLT), in the percentage of 13% to 36% and 5% to 15%, respectively.
  • Prompt and systematic evaluation of abnormal liver enzymes after liver transplant surgery is crucial to identify biliary strictures at an early stage.
  • Clinicians are advised to retain a high index of suspicion, especially in the first year after the transplant, and investigate all liver function abnormalities with a magnetic resonance cholangiopancreatography (MRCP) to allow early recognition.
  • Endoscopic retrograde cholangiopancreatography should be used as the initial therapy for biliary strictures.
  • Endoscopist must ascertain the full operative details of the biliary and liver anatomy.
  • The rendezvous method, magnetic compression anastomosis and peroral cholangioscopy, endoscopic ultrasound guided-biliary drainage (EUS-BD) are options in difficult scenarios.

Dr. Manoj K Sahu

Dr. Manoj K Sahu is an Senior Consultant - Gastroenterologist, Hepatologist & Interventional Endoscopist. He has completed MBBS, MD-(Medicine), DM-(Gastroenterology, CMC Vellore) FSGEI, FISG, MNAMS. He has been awarded Rajyapuraskar (2015), the KGF Sammana (2014), the Times Health Icon award, Mission Odisha Seva Sammana, and the Nosaca award. He has published 12 publications in National and International Journals.


Medtalks is India's fastest growing Healthcare Learning and Patient Education Platform designed and developed to help doctors and other medical professionals to cater educational and training needs and to discover, discuss and learn the latest and best practices across 100+ medical specialties. Also find India Healthcare Latest Health News & Updates on the India Healthcare at Medtalks