Successful endoscopic and surgical management of non-anastomotic biliary strictures after liver transplantation - case report.

BACKGROUND: One of the most relevant biliary complications after liver transplantation are non-anastomotic strictures which occur in about 10-15%. Untreated they lead to cholestasis, severe graft dysfunction, septic complications, secondary cirrhosis and even death. To date they are usually treated by endoscopic or percutaneous placement of stents and balloon dilatation. A significant amount of patients with non-anastomotic strictures require a liver retransplantation.

CASE REPORT: A 64 year old patient suffering from HCV induced liver cirrhosis underwent liver transplantation at our hospital. Two months after transplantation due to elevated parameters of cholestasis the patient underwent an endoscopic retrograde cholangiography. Multiple strictures of the bile duct were observed and treated by endoscopic and percutaneous methods until a significant amelioration of the pathological finding in the right liver lobe was achieved. Unfortunately biliary strictures remained in the left liver lobe being resistant to the previous method of treatment. We thus decided to perform a left hemihepatectomy. The postoperative course was unremarkable.

CONCLUSIONS: The treatment of our patient consisted of over 25 endoscopic and percutaneous interventions and a left hemihepatectomy. The patient was followed up for two years, during which he had no further complaints being in good health. We demonstrated an example of a successful management of one of the most severe late biliary complications after liver transplantation - the non-anastomotic strictures - avoiding a retransplantation of the organ by endoscopic, percutaneous and surgical intervention. Thus a graft resection seems to be possible.