title: Living-related liver transplantation in a patient with end-stage hepatolithiasis and a biliary-bronchial fistula.
abstract: Liver transplantation in patients with end-stage hepatolithiasis is complicated by the high incidence of the suppurative cholangitis and systemic infection. A 43-year-old Korean-Japanese woman with hepatolithiasis, biliary cirrhosis, suppurative cholangitis, and biliary-bronchial fistula underwent living-related liver transplantation (LRLT) using a right lobe graft of her sister. The risk of infection was minimized by preoperative percutaneous transhepatic biliary drainage initiated 2 months before transplantation. The native liver was resected en bloc with the extrahepatic bile ducts and the infected section of the right hemidiaphragm. Opportunistic infection was prevented by limiting antimicrobial therapy to the interval from preoperative day 3 to postoperative day 4. Immunosuppressive agents were given below standard dose. The postoperative course following LRLT was uncomplicated, and hepatic function was good. Careful management of infection and adequate graft size are essential for successful LRLT in patients with end-stage hepatolithiasis.
authors.affiliation: Department of Hepatobiliary-Pancreatic and Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hirohashi
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Akishige
authors.initials: A
authors.lastname: Kanazawa
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.forename: Koichi
authors.initials: K
authors.lastname: Ohno
authors.forename: Tadashi
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hamba
authors.forename: Taichi
authors.initials: T
authors.lastname: Shuto
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D001653:Bile Ducts, Intrahepatic; D001658:Biliary Fistula / Q000150:complications*; D001983:Bronchial Fistula / Q000150:complications*; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors