Endoscopic treatment of post-liver transplantation biliary leaks with stent placement across the leak site

Background: Biliary tract leaks occur in over 10% of patients undergoing liver transplantation and are the most common cause of biliary tract-related death in these patients. A number of treatment options are available, but a standard approach has not been established. Methods: Twenty-six patients were retrospectively studied who had post-transplantation leaks develop with special reference to those who underwent endoscopic placement of a "leak-bridging" stent. Results: Endoscopic retrograde cholangiography was performed in all cases with no procedure-related complications.Twenty-four patients had a leak-bridging stent, 1 a transpapillary stent, and 1 a nasobiliary drain. Leak resolution occurred in 23 cases (88%) after initial stent placement. The median time to stent removal was 8 weeks. Three patients did not respond to initial treatment; 2 were successfully treated with another stent and a single patient required surgical repair. Four deaths occurred during follow-up, all unrelated to the biliary leak. Conclusions: Placement of a leak-bridging stent is a safe and effective initial treatment for post-liver transplantation biliary leaks.