Despite technical modifications and application of various surgical techniques, biliary tract complications continue to be a major source of morbidity after orthotopic liver transplantation (OLTx). Aim: to assess the incidence and management of biliary complications within a single liver transplant unit. One hundred and eighty four consecutive cadaveric liver transplants have been performed at King Fahd National Guard Hospital from February 1994 till July 2004. Data regarding biliary complications in liver transplant recipients was reviewed retrospectively. We analyzed the incidence and the type of biliary complications, the management sequence and its success rate. Success was defined as no further need for biliary intervention. The correlation between the modality of biliary reconstruction and the type and incidence of biliary complications was analyzed. Thirty-two cases developed biliary complications giving an overall incidence of 17.4% per cent. There was a higher incidence of complications in the hepatico-jejunostomy group (21.5%) compared with the duct-to-duct technique (15.1%). Bile leakage occurred in 12 cases. Endoscopic stent insertion and radiological techniques were successful in 8 cases (66.6%), while surgery was mandatory in 4 cases (33.3%). Out of the 12 cases with initial leaks, 6 cases developed a subsequent stricture (50%). There were 26 cases of biliary strictures, with a bi-modal distribution (14 cases <6 months, 12. cases >6 months). Twenty-two cases (84.6%) were initially managed using nonsurgical techniques, with a success rate of 59%, while 13 cases required further surgery.
Biliary complications remain as an important cause of morbidity after OLTx. They can usually be managed percutaneously or endoscopically, however tight strictures and major leaks frequently require surgical intervention.