Posttransplant Complications: Biliary and Vascular

Since it was first described, the overall patient and graft survival after liver transplant have improved with advances in immunosuppression and surgical and anesthetic techniques. Despite this improvement, there continues to be both biliary and vascular complications associated with this life-saving operation, which can lead to further procedures, reoperation, and retransplant. Advances in endoscopic and percutaneous techniques have had a significant impact on the perioperative management of posttransplant complications, resulting in a reduction in reoperations and retransplants. Changes in intraoperative management with the use of thrombolytic therapy have allowed for the expansion of the donor pool, allowing the use of donation after cardiac death with increased safety and decreased risk of ischemic biliary tract injury. This article serves to highlight the vascular and biliary complications following transplant, their etiology, diagnosis, and management. This review contains 9 figures, 1 table, and 33 references.  Key Words: bile leak, biliary stricture, deceased donor liver transplant, donation after brain death (DBD), donation after cardiac death, hepatic artery thrombosis, ischemic cholangiopathy, living donor liver transplant, portal vein thrombosis, thrombolytic therapy, venous outflow obstruction.