Liver Transplantation for Common Bile Duct Injury

Indications for liver transplantation after bile duct injury fall into two major categories: Chronic liver disease due to secondary biliary cirrhosis and acute liver failure due to an associated major vascular injury. The exact incidence of liver transplantation due to biliary injury is difficult to estimate because the etiology of liver failure for these patients is not always adequately captured in current transplant registries. There is a rare but important role and need for liver transplant in highly selected cases of bile duct injury. While the etiology of obstruction leading to secondary biliary cirrhosis is not consistently reported, most cases series describe the use of transplantation as a consequence of iatrogenic injury. This chapter will review the existing literature, pathogenesis, and histology of liver disease associated with bile duct injury, evaluation of the potential transplant recipient, and technical factors in this patient group.