title: Biliary complications after living donor adult liver transplantation.
abstract: The highest rate of complications characterizing the adult living donor liver transplantation (ALDLT) are due to biliary problems with a reported negative incidence of 22-64%. We performed 23 ALDLT grafting segments V-VIII without the middle hepatic vein from March 2001 to September 2005. Biliary anatomy was investigated using intraoperative cholangiography alone in the first five cases and magnetic resonance cholangiography in the remaining 18 cases. In 13 cases we found a single right biliary duct (56.5%) and in 10 we found multiple biliary ducts (43.7%). We performed single biliary anastomosis in 17 cases (73.91%) and double anastomosis in the remaining six (26%) cases. With a mean follow up of 644 days (8-1598 days), patient and graft survivals are 86.95% and 78.26%, respectively. The following biliary complications were observed: biliary leak from the cutting surface: three, anastomotic leak: two, late anastomotic strictures: five, early kinking of the choledochus: one. These 11 biliary complications (47.82%) occurred in eight patients (34.78%). Three of these patients developed two consecutive and different biliary complications. Biliary complications affected our series of ALDLT with a high percentage, but none of the grafts transplanted was lost because of biliary problems. Multiple biliary reconstructions are strongly related with a high risk of complication.
authors.affiliation: Department of Hepatobiliary Surgery and Transplantation, Niguarda Hospital, Milan, Italy. alex.giaco@libero.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giacomoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Lauterio
authors.forename: Abdallah O
authors.initials: AO
authors.lastname: Slim
authors.forename: Angelo
authors.initials: A
authors.lastname: Vanzulli
authors.forename: Antonella
authors.initials: A
authors.lastname: Calcagno
authors.forename: Iacopo
authors.initials: I
authors.lastname: Mangoni
authors.forename: Luca S
authors.initials: LS
authors.lastname: Belli
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gasperi
authors.forename: Luciano
authors.initials: L
authors.lastname: De Carlis
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000378:metabolism; D001659:Biliary Tract / Q000293:injuries*; D005260:Female; D006503:Hepatic Veins / Q000378:metabolism; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors