title: Biliary complications in living related liver transplantation.
abstract: BACKGROUND
  Biliary tract reconstruction has long been considered the Achilles' heel of liver transplantation as biliary complications can increase morbidity and mortality especially in partial liver graft transplantation.
  
  
  METHODS
  Thirty-four living related liver transplants were performed at Chang Gung Memorial Hospital in Kaohsiung for 33 children and 1 adolescent during a 5.5-year period. All potential donors underwent a detailed preoperative imaging study of the vascular and biliary anatomy, including three-dimensional helical computed tomographic cholangiography (n = 20), magnetic resonance cholangiography (n = 14), and intra-operative cholangiography (n = 31) before graft retrieval. All hepatic artery anastomoses were performed in the standard microsurgery fashion and their patency was confirmed intra-operatively using Doppler ultrasound.
  
  
  RESULTS
  The biliary complication rate was 8.8% (3/34), including multiple intrahepatic biliary stenosis of unknown origin (n = 1), bile leakage from the Roux-en-Y loop (n = 1), and a missed biliary radicle (n = 1) which were treated via interventional radiological and surgical procedures. The overall graft and patient survival rates were 100%.
  
  
  CONCLUSIONS
  The biliary complication rate in this series was low compared to those of other experienced centers. Complete study of the variations of intrahepatic duct ramification pre-and-intra-operatively provided adequate information on the appropriate transection plane. Furthermore, intra-operative Doppler ultrasound verification of vessel patency helps prevent vascular complications, which has been identified as a cause of biliary complications.
authors.affiliation: Department of Radiology, Liver Transplant Program, Department of Surgery, Chang Gung Memorial Hospital, 123, Tao-Pei Road, Niaosung, Kaohsiung, Taiwan, R.O.C.
authors.forename: Y F
authors.initials: YF
authors.lastname: Cheng
authors.forename: Y S
authors.initials: YS
authors.lastname: Chen
authors.forename: T L
authors.initials: TL
authors.lastname: Huang
authors.forename: T Y
authors.initials: TY
authors.lastname: Chen
authors.forename: V
authors.initials: V
authors.lastname: de Villa
authors.forename: T Y
authors.initials: TY
authors.lastname: Lee
authors.forename: C C
authors.initials: CC
authors.lastname: Wang
authors.forename: S H
authors.initials: SH
authors.lastname: Wang
authors.forename: Y C
authors.initials: YC
authors.lastname: Chiang
authors.forename: H K
authors.initials: HK
authors.lastname: Cheung
authors.forename: B
authors.initials: B
authors.lastname: Jawan
authors.forename: C L
authors.initials: CL
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D018608:Ultrasonography, Doppler