Introduction: Orthotopic liver transplantation (LT) is the chosen treatment for end-stage liver disease. Despite the advances in the surgical techniques, biliary tract complications are the most common problems seen after transplantation with an incidence range of 10-25%. We aim to describe the incidence of biliary complications at our center.

Patients and Methods: Retrospective study of patients who suffered from biliary complications after LT between September 2009 and February 2022 in a single center. Demographic characteristics: cause of liver failure, MELD score, time on waiting list (WL), DRI, national, regional or local procurement; preservation solution, warm ischemia time (WIT), cold ischemia time (CIT), chosen treatment and success rate (SR), patient and graft survival. Biliary complications were divided into 2 groups, according to the moment of appearance: early complication (EC) when they happened within the first 30 post-operative days and delayed complication (DC) when they ocurred afterwards. All analyses were performed using IBM SPSS v25.0.

Results: From a total of 549 LT that were performed during the period of study, 90 (16%) had biliary tract complications. Among them, 78 were adult recipients, with a mean age of 48 years old (DS 21). Sixty-four transplants (71%) were performed due to cirrhosis, caused mainly due to viral disease (25, 39%) and alcohol (18, 28%). Sixty-nine (90%) were performed with whole liver and 8 (10%) with partial grafts (7 right and 1 left lobe). The most frequent biliary complication in the EC and DC group was the biliary anastomotic stenosis, with 21 (60%) and 33 cases (78%), respectively. Eighteen patients (23%) lost their graft (7 EC and 11 DC). Table 1 shows biliary complications according to time of appearance and initial treatment chosen.

Among the pediatric patients, the mean age was 3 years old (range 1-10) and the main cause for transplant was biliary atresia (5, 42%). Nine patients suffered of biliary leak (8 within the EC groups and 1 DC) and 3 of biliary anastomotic stenosis (2 EC and 1 DC). Three patients (25%) lost their grafts (all from EC). Table 2 shows biliary complications according to time of appearance and initial treatment chosen.

Discussion: Biliary complications remain a major cause of morbidity, dysfunction, and mortality in liver transplant recipients and continue to be a challenging aspect in the management of such patients. With appropriate management, however, there impact on  graft and overall survival could be minimized.