Intervention Strategies of Nonanastomotic Biliary Strictures: From Mechanical Repair to Biological Reconstruction.

Nonanastomotic strictures (NAS) are the most troublesome biliary complications following liver transplantation. This narrative review systematically summarizes the interventions of NAS, such as prevention methods (eg, machine perfusion) and conventional treatments (eg, endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography). Magnetic compression anastomosis is an alternative to endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography in complex anatomical sites. Additionally, taking into consideration the current therapeutic strategy shift from mechanical repair to biological reconstruction, applications of mesenchymal stem cells and organoids are also discussed. However, the clinical application of organoids requires further investigation. Additionally, retransplantation is the definitive treatment of NAS and has efficacy on ischemic biliary lesions. Current intervention for NAS remains palliative, and endoscopic retrograde cholangiopancreatography is regarded as the main therapeutic strategy. Future investigations need to focus on powered studies investigating prevention, the combination of different interventions, and the translation of regenerative medicine. Effective interventions for NAS are important for improving the prognosis and long-term graft function of recipients.