Clin Transplant Res.  2025 Mar;39(1):71-76. 10.4285/ctr.24.0050.

Biliopleural fistula in a liver recipient after left lobe living donor liver transplantation: a case report

• Saparbay J
• Sharmenov A
• Zhumukov A
• Razmazina A
• Aytbayev C
• Spatayev Z
• Mukazhanov A

• KMID: 2566582
• DOI: http://doi.org/10.4285/ctr.24.0050

Abstract

Biliopleural fistula (BF) is an uncommon complication that can occur after liver transplantation (LT). This condition, characterized by pleural biliary effusion, can lead to severe complications, particularly in immunocompromised patients. In this report, we present a clinical case detailing the successful treatment of BF following an adult-toadult left lobe living donor LT (LDLT). A 61-year-old female underwent left lobe LDLT. The early postoperative period was complicated by bile leakage and biliary stricture. To address the biliary stricture, biloma evacuation and endoscopic retrograde cholangiography (ERCP) with sphincterotomy were performed. On postoperative day (POD) 2 after ERCP, the patient developed a BF. Thoracostomy drainage successfully resolved the effusion within 2 weeks, during which time the diameters of the biliary ducts normalized on ultrasonography. The patient was discharged on POD 70 with normal liver graft function. Although rare, BF following LT can lead to significant complications due to the recipient's immunosuppressed state and heightened risk of infection. Therefore, a pleural effusion persisting for more than 4 weeks after surgery should raise suspicion of BF, especially in patients with a history of early bile leakage and biliary stricture.

Keyword

Pleural effusion, Biliary; Liver transplantation; Living donors; Case report

Figure

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  Fig. 1 (A) Chest computed tomography with no signs of pleural effusion (B) Computed tomography with bile leakage along the right subdiaphragmatic region (biloma is noted with a red arrow).

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  Fig. 2 Image of endoscopic retrograde cholangiopancreatography with visible extravasation of the contrast, dilated common bile, anastomotic biliary stricture. The red arrow indicates the bile leakage and accumulation under the diaphragm and the green arrow indicates the area of anastomotic stricture.

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  Fig. 3 Chest X-ray after pigtail insertion; the pleural biloma is visible. (A) Chest X-Ray after pigtail insertion. (B) Chest X-ray just before pigtail insertion.

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  Fig. 4 Chest X-ray of the right pleural cavity with a pigtail drain inserted into the biloma in the right pleural cavity.

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  Fig. 5 Fistulography through external biliary drain with remnant small volume bile leakage and persistent biliary stricture.

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  Fig. 6 Cholangiography image through the percutaneous transhepatic biliary drainage inserted into the dilated left hepatic duct of the left liver graft.

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