biliary complications after LTX

1. Biliary complications
after LDLT
Ahmed Abdul Ghani MD
Lecturer of Internal medicine, Hepatology
Member of Liver Transplantation team,
Manial sp. Hespital

2. Kasr Al-Aini LTX program
Program was initiated 2001.
2001
First case 22 Oct 2004.
22 Oct. 2004
82 cases by the end of 2010.
end of 2010
250 cases.
now
48 Ped cases till now
now

3. Location & types of Biliary
Complications
• Donor bile Duct
- Ischemic type biliary lesion
- Hepatic artery thrombosis with
biliary destruction
• Bile duct anastomosis
- Leakage
- Stricture
• Recipient Biliary system
- Stones
- Ampullary dysfunction

4. Timing of
Biliary
Complications

5. Risk Factors
1) Graft - related factors:
• Donation after cardiac death.
• Older age of donor.
• ABO mismatch.
• Prolonged cold & warm ischemia time.
2) Peri - Operative factors:
• Hepatic artery complications.
• Technical factors during surgery.
• Presence of bile leak.
3) Non-operative factors:
• Acute cellular rejection.
• Cytomegalovirus infection.
• Previous diagnosis of primary sclerosing cholangitis.

6. Non specific symptoms Anorexia, Malaise
Mild abd. discomfort
Pruritus, Jaundice
Cholangitis, Bile ascites
• The clinical presentations is variable according to the type of lesion.

7. Diagnostic
Approach
Starts with a high index of
suspicion along with abdominal
US & doppler examination.
MRCP is highly sensitive and is
usually reserved for
confirmation.

8. MRC showing a CBD
stone with bile duct
dilation

9. Management
The vast majority of these
complications can be
successfully treated with ERCP.
PTC or surgery is
recommended if ERCP cannot
be performed.

10. Anastomotic biliary stricture 2 plastic stents placed side by side after dilatation

11. Case presentation
• 3-year-old boy known to have hepatorenal tyrosinemia. 6 months
after medical treatment, he received left lateral segment from his
mother in 2018
• Two months post-transplant, he developed elevation in the biliary
enzymes associated with itching and clay stools. Abdominal
ultrasound showed minimal intrahepatic biliary radical dilatation.
MRCP revealed mild dilatation of the intrahepatic biliary radicals with
anastomotic stricture.

16. Thank you