Abstract
Background. Biliary complications remain a major cause of morbidity after liver transplantation, with a higher incidence reported in living donor liver transplantation compared with deceased donor liver transplantation. This study aimed to systematically evaluate the incidence, risk factors, and clinical outcomes of biliary complications following liver transplantation. Materials and Methods. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Data were retrieved from PubMed/MEDLINE, Scopus, and Web of Science up to 2025. Observational cohort and comparative studies reporting biliary complications after living donor liver transplantation and/or deceased donor liver transplantation were included. Results. Fifteen studies comprising 16,579 patients were included. The overall incidence of biliary complications ranged from 10% to 35%, reaching up to 40% in living donor liver transplantation recipients. Meta-analysis demonstrated a significantly higher risk of biliary complications in living donor liver transplantation compared with deceased donor liver transplantation (OR = 1.96). Anastomotic strictures were the most common complication, while non-anastomotic strictures were associated with poorer graft survival and increased retransplantation rates. Key risk factors included multiple biliary anastomoses, ischemia–reperfusion injury, hepatic artery thrombosis, and prolonged cold ischemia time. Conclusions. Biliary complications remain a frequent and clinically significant problem after liver transplantation, particularly in living donor liver transplantation. Their development is multifactorial, predominantly driven by ischemic and technical factors. These findings highlight the importance of optimizing surgical techniques and perioperative management to improve graft outcomes.