Biliary strictures in the liver transplant patient

Biliary complications are the most common adverse events following liver transplantation (LT). Living donor LT have a higher rate of biliary complications compared with deceased donor LT. Multiple risk factors have been implicated in the development of biliary strictures, which could be categorized into recipient, graft, operative factors, and postoperative factors. Bile duct strictures following LT are classified as biliary anastomotic strictures or nonanastomotic strictures. Nonanastomotic strictures have a less favorable response to endoscopic management. Magnetic resonance cholangiopancreatography is the first-choice examination when a biliary complication is suspected following LT. For treating anastomotic strictures, endoscopic retrograde cholangiopancreatography directed balloon dilatation complemented with the placement of multiple plastic stents has become the standard of care and results in stricture resolution in over 90% of cases. Temporary placement of fully covered self-expanding metal stents (FCSEMSs) has not been demonstrated to be superior mostly because of the high migration rate of current FCSEMSs models. FCSEMS with special antimigratory design may be superior and cost-effective compared with multiple plastic stents, but need evaluation in prospective and randomized trials.