Abstract: Objective To investigate the approaches to diagnosis, treatment and prevention of the biliary complications after
orthotopic liver transplantation (OLT). Methods The clinical data were collected from 258 adult patients receiving orthotopic
liver transplantation between August, 2004 and December, 2011, among whom 56 patients with biliary complications were
identified to analyze the diagnosis and treatment of the complications. Results The incidence of biliary complication was
22.13% in the 258 recipients of secondary liver transplantation. Of the 56 patients with biliary complication, 32 (57.14%) had
biliary stricture and 24 (42.86%) had bile leakage; 36 (64.29%) patients presented a simple type of biliary complication and 20
(35.71%) had a composite type, including bile leakage, biliary obstruction, biliary calculi, biliary tract infections, biliary sludge
formation, and biliary tract bleeding. Thirty-one patients (55.36%) underwent routine endoscopic retrograde cholangiopancreatography
(ERCP), percutaneous transhepatic cholangiography (PTC) and other endoscopic or interventional treatments, and 23
(74.19%) were cured or showed improvement, while 3 died due to multiple organ dysfunction syndrome (MODS). Conclusion
Appropriate surgical approaches and skills in bile duct anastomosis are crucial to reduce the incidence of biliary complications
following liver transplantation. Non-surgical treatment (including ERCP) is the primary option, followed by surgical bile duct
exploration, for the management of biliary complications; liver retransplantation is the most effective life-saving means for
patients with liver graft non-function. But still, prevention of biliary complications is of pivotal importance to improve the
outcome of liver transplantation.