Endoscopic management of postoperative biliary complications in donors for living donor liver transplantation.
OBJECTIVE
Biliary leakage and stricture are serious complications that occur in donors whose liver is resected for living donor transplantation. We assessed the usefulness of endoscopic nasobiliary drainage and endoscopic biliary stenting, respectively, in repairing biliary leakage and stricture.


METHODS
Between July 1999 and December 2001, a total of 276 donors underwent liver resection (left side, 118; right side, 158) for living donor transplantation at Kyoto University Hospital. Seven (2.5%) donors developed biliary leakage, which required endoscopic nasobiliary drainage; 3 of these donors also had biliary stricture.


RESULTS
All 7 patients who developed biliary leakage were the right-lobe donors. Endoscopic retrograde cholangiography identified the site of the biliary leakage in all 7 of the donors. In 6 of these donors, the biliary leakage resolved within an average of 15 days after an endoscopic nasobiliary drainage tube was placed. In the seventh donor, the biliary leakage resolved after percutaneous transhepatic biliary drainage was performed. Three patients developed biliary stricture that required endoscopic biliary stenting. The angles between common hepatic duct and the left hepatic duct were more acute in patients with stricture than in those without stricture (62 degrees vs. 119 degrees).


CONCLUSIONS
Biliary complications requiring endoscopic treatment developed exclusively in donors for right-lobe living donor transplantation. Endoscopic retrograde cholangiography is a favorable modality for diagnosing and treating postoperative biliary complications in donors for living donor liver transplantation.
Hasegawa
Kazunori
K
Department of Gastroenterology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Yazumi
Shujiro
S
Egawa
Hiroto
H
Tamaki
Hiroyuki
H
Asada
Masanori
M
Kodama
Yuzo
Y
Hisatsune
Hiroshi
H
Okazaki
Kazuichi
K
Tanaka
Koichi
K
Chiba
Tsutomu
T
D000328:Adult; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D016145:Endoscopy, Digestive System; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015607:Stents