Biliopleural fistula in a liver recipient after left lobe living donor liver transplantation: a case report.

Biliopleural fistula (BF) is an uncommon complication that can occur after liver transplantation (LT). This condition, characterized by pleural biliary effusion, can lead to severe complications, particularly in immunocompromised patients. In this report, we present a clinical case detailing the successful treatment of BF following an adult-to-adult left lobe living donor LT (LDLT). A 61-year-old female underwent left lobe LDLT. The early postoperative period was complicated by bile leakage and biliary stricture. To address the biliary stricture, biloma evacuation and endoscopic retrograde cholangiography (ERCP) with sphincterotomy were performed. On postoperative day (POD) 2 after ERCP, the patient developed a BF. Thoracostomy drainage successfully resolved the effusion within 2 weeks, during which time the diameters of the biliary ducts normalized on ultrasonography. The patient was discharged on POD 70 with normal liver graft function. Although rare, BF following LT can lead to significant complications due to the recipient's immunosuppressed state and heightened risk of infection. Therefore, a pleural effusion persisting for more than 4 weeks after surgery should raise suspicion of BF, especially in patients with a history of early bile leakage and biliary stricture.