title: Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation.
abstract: A considerable proportion of adult living donor liver transplantation (LDLT) recipients experience biliary complication (BC), but there are few reports regarding BC based on long-term studies of a large LDLT population. The present study examined BC incidence, risk factors and management using single-center data from 259 adult patients (225 right liver and 34 left liver grafts) between 2000 and 2002. The mean follow-up period was 46 +/- 14 months. Biliary reconstruction included single duct-to-duct anastomosis (DD, n = 141), double DD (n = 19), single hepaticojejunostomy (HJ, n = 67), double HJ (n = 28), and combined DD and HJ (n = 4). There were 12 episodes of anastomotic bile leak and 42 episodes of anastomotic stenosis in 50 recipients. Most leaks occurred within the first month, whereas stenosis occurred over 3 yr. Most stenoses were successfully treated using radiological intervention. Cumulative 1-, 3-, and 5-yr BC rates were 12.9%, 18.2%, and 20.2%, respectively. BC occurred much more frequently in right liver grafts compared to left liver grafts (P = 0.024). Stenosis-free survival curves for right liver graft recipients were similar for all reconstruction groups. When right liver graft recipients with single biliary reconstructions were grouped according to graft duct size and type of biliary reconstruction, DD involving a small-sized duct (less than 4 mm in diameter) was found to be a BC risk factor (P = 0.015), whereas HJ involving such duct sizes was not found to be associated with a higher risk (P = 0.471). In conclusion, close surveillance for BC appears necessary for at least the first 3 yr after LDLT. We found that most BC could be successfully controlled using radiological intervention. In terms of anastomotic stenosis risk, HJ appears a better choice than DD for right liver grafts involving ducts less than 4 mm in diameter.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Kyu-Bo
authors.initials: KB
authors.lastname: Sung
authors.forename: Kwang-Min
authors.initials: KM
authors.lastname: Park
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Lee
authors.forename: Sung-Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Gyu-Sam
authors.initials: GS
authors.lastname: Hwang
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Dong-Sik
authors.initials: DS
authors.lastname: Kim
authors.forename: Jae-Pil
authors.initials: JP
authors.lastname: Jung
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
mesh_terms: D000328:Adult; D001649:Bile Duct Diseases / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012307:Risk Factors