Test Your Guidelines Knowledge

A 54-year-old man with primary sclerosing cholangitis stage 4 (biliary cirrhosis) is admitted to the hospital with a third episode of acute bacterial cholangitis within 1 year. He had previously undergone a MRCP that showed a high-grade stricture in the common bile duct.

Which of the following is the most important step that needs to be performed before considering liver transplantation?