Identification and treatment of biliary complications after liver transplantation:more relevant than ever

Liver transplantation remains the treatment of choice for patients with end-stage liver diseases.Given the increasing demand for liver transplantation,the spectrum of potential grafts has been widened and includes now not only regular grafts from donation after brain death(DBD)but also organs from donation after cardiac death(DCD),split liver and living donor grafts,as well as so-called“marginal grafts”from donors with extended criteria such as significant steatosis hepatis or older age(1).These grafts are associated with higher rates of early allograft dysfunction and primary non-function-which stresses the healthcare system with increased length of hospital stay for patients and higher costs(2,3).Moreover,marginal grafts are at risk for biliary complications such as anastomotic and non-anastomotic strictures as well as biliary leakages,which is caused by more severe ischemia reperfusion injury and in consequence reduced micro perfusion of the biliary tract(4).