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Incidence and management of biliary strictures in living‐related donor graft

Orthotopic liver transplantation (OLT), especially for small children, has been limited by the cadaveric donor organ shortage (1). In order to overcome this problem, split liver transplantation (SLT) and living-related liver transplantation (LRLT) have been developed, and many centers have accepted the feasibility of these techniques (2, 3). The number of new registered liver transplant candidates has been increasing (4), and LRLT will remain in the mainstream of treatments for end-stage liver disease unless cadaveric organ donation becomes well organized. Since Calne (5) referred to the biliary tract as the Achilles heel of liver transplantation in 1976, biliary complications have remained a significant source of morbidity and mortality. Furthermore, recent studies have reported a higher incidence of biliary complications after SLT and LRLT than after OLT (6, 7). With the accelerated application of adult and pediatric LRLT, special attention should be paid to biliary strictures as a long-term complication of surgery.