Introduction : Biliary complications after liver transplantation(LT) are most common complications and associated with morbidity and mortality. Currently, the generally applied first intervention for post-LT biliary complications is Endoscopic retrograde cholangiopancreatography(ERCP) because of less invasiveness and patient convenience. However, there has not been a uniform conclusion published on superiority of the two types of intervention as first trial. Therefore, we compared the efficacy of ERCP and percutaneous transhepatic biliary drainage(PTBD) as a first line treatment of post-LT biliary problems.

Methods : From January 2013 to December 2016, 565 patients underwent LT in Seoul National University Hospital(SNUH). Medical records of LT recipients with biliary complications retrospectively reviewed. Long-term follow-up was evaluated using cholangiogram, computed tomography(CT) scan and laboratory parameters.

Results : Among 565 LT patients, 85 patients(15.0%) were treated by intervention including ERCP and PTBD with diagnosis of biliary complications. Successful intervention on the first attempt was achieved in 36 of 60 patients(60.0%) with ERCP, and 19 of 25 patients(76.0%) with PTBD, respectively(p=0.16). We also classified the groups based on the location of the biliary complications and compared the success rate; one with anterior bile duct problems (a-BD, n=29) and another with posterior bile duct (p-BD, n=14). In a-BD, there was no difference in the intervention success rate of PTBD and ERCP(25% vs.24%, p=0.692). However, in p-BD, PTBD success rate was significantly better than ERCP(75% vs.18%, p=0.002).

Conclusions : PTBD could be considered as more effective procedure for termination of treatment in patients with post-LT biliary complications, especially posterior duct problems.