title: Endoscopic management of biliary complications after adult living donor liver transplantation.
abstract: OBJECTIVE
  Biliary complications and their treatment in adult cadaveric liver transplantation (CLT) are well described. However, biliary complications and their management in living donor liver transplantation (LDLT) are not well characterized. We assessed the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and management of biliary complications following LDLT.
  
  
  METHODS
  We performed a retrospective cohort analysis of all LDLT recipients with duct-to-duct anastomoses (n = 15). Specific data included referral for ERCP, diagnosis, and therapy. Comparisons were made to a 260 CLT recipient cohort.
  
  
  RESULTS
  Greater percentage of LDLT recipients underwent ERCP (73%) compared to CLT recipients (25%; p= 0.001). Biliary complications diagnosed by ERCP in LDLT recipients consisted of bile leaks and strictures, and were more frequent than in CLT recipients (leaks: 53%vs 12%; p= 0.001; strictures: 27%vs 5%; p= 0.01). Most leaks occurred at T-tube sites (LDLT: 87%; CLT: 65%). Diagnosis and therapy of leaks required a median of 2 ERCP procedures in both groups. Bile leaks were successfully treated endoscopically in 100% and 84% of LDLT and CLT recipients, respectively (p= 0.56). Most biliary strictures were anastomotic (LDLT: 100%; CLT: 64%). Strictures were diagnosed and treated with a median of 1.5 and 2 ERCP procedures in the LDLT and CLT groups, respectively. The duration of endoscopic therapy was a median of 10 and 14 wk, and success rates were 75% and 62% (p= 1.0) in LDLT and CLT groups, respectively.
  
  
  CONCLUSIONS
  LDLT is associated with increased biliary complications as compared to CLT. ERCP is useful for diagnosis, can successfully treat most LDLT-related biliary complications, and should be attempted prior to more invasive interventions.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
authors.forename: Janak N
authors.initials: JN
authors.lastname: Shah
authors.forename: Nuzhat A
authors.initials: NA
authors.lastname: Ahmad
authors.forename: Kirti
authors.initials: K
authors.lastname: Shetty
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kochman
authors.forename: William B
authors.initials: WB
authors.lastname: Long
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Brensinger
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Pfau
authors.forename: Kim
authors.initials: K
authors.lastname: Olthoff
authors.forename: James
authors.initials: J
authors.lastname: Markmann
authors.forename: Abraham
authors.initials: A
authors.lastname: Shaked
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Ginsberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015331:Cohort Studies; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies