Objective  To evaluate the causes

diagnosis

and management of intrahepatic biliary strictures (IBS) after orthotopic hepatic transplantation.   Methods  Clinical dates of 407 patients who underwent orthotopic liver transplantation from February 1999 to February 2007 were retrospectively reviewed.   Results  Among the 407 patients

22(5.4%) patients developed IBS which was diagnosed by cholangiography and magnetic resonance cholangiopancreatography (MRCP). The incidence of IBS was statistically significantly associated with the duration of cold ischemic storage of allografts more than 12 h (107 cases)

the use ABO incompatible grafts (13 cases)

postoperative hepatic arterial occlusion (5 cases)

and pretransplantation HBV-related fulminant or subacute hepatic failure (91 cases). While

the incidences of IBS of them were was10 cases

4 cases

3 cases

and 10 cases respectively. These patients with IBS were treated with drugs

endoscopic retrograde cholangiopancreatography (ERCP)

transhepatic cholangiography (PTC)

operation and retransplantation. Among these 22 IBS patients

17 patients got improved

9 was cured

5 were died

and 22 lost the graft due to IBS.   Conclusion  The duration of cold ischemic storage of allografts (more than 12 h)

the use ABO incompatible grafts

postoperative hepatic arterial occlusion

and pretransplantation HBV-related fulminant or subacute hepatic failure appear to be important risk factors that cause IBS. Cholangiography and MRCP are main measures to diagnose IBS. Management should be taken according to different types of IBS.