How are the biliary complications of whole-liver orthotopic liver transplantation (OLTX) treated?

Updated: Mar 01, 2019
  • Author: Paul D Russ, MD; Chief Editor: John Karani, MBBS, FRCR  more...
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Answer

Answer

The choices for mechanical revision of a bile duct stricture include PTC, ERCP, and repeat operation. Ischemic bile duct strictures can present with rapid onset of allograft dysfunction and sepsis. Unlike the native biliary tree, which is supplied by collaterals from the gastroduodenal artery, the harvested donor bile duct and the anastomotic end of the recipient duct are solely dependent on the hepatic artery. Compromise of the hepatic artery by HAS or HAT results in abrupt ischemia and necrosis of the biliary epithelium. This causes strictures, disruption of the ducts, bile leaks, bilomas, infected bilomas, and abscesses.

Timely angiographic correction of HAS or HAT occasionally can result in graft salvage. [28, 29] Percutaneous drainage of associated fluid collections is often only a temporizing measure, because severe underlying biliary tree damage has usually occurred. Patients with sepsis who have severe biliary and hepatic damage from HAS or HAT require retransplantation for ultimate survival.


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