Endoscopic management of biliary complications after adult living donor liver transplantation.
OBJECTIVE
Biliary complications are one of the important issues to be addressed after liver transplantation. Endoscopic management of biliary complications after deceased donor liver transplantation (DDLT) is widely accepted, but it remains to be established in patients after living donor liver transplantation (LDLT). Endoscopic management in LDLT patients is difficult mainly because of the complexity of duct-to-duct reconstruction.


METHODS
A total of 174 adult LDLTs with duct-to-duct reconstruction were performed in our institution. Biliary complications developed in 53 patients (30%). Among these, 18 patients were referred for endoscopic management and were the subjects of the present study. Success rate, early morbidity, and outcome were evaluated in these 18 patients.


RESULTS
The type of graft was the right liver in six, left liver in eight, and right lateral sector in four patients. Ten out of 18 patients had one biliary anastomosis and the remaining eight had multiple anastomoses. Six patients had a previous history of surgical or percutaneous intervention for biliary complications after LDLT. Seventeen patients had one or more biliary strictures. Biliary casts were found in nine patients, three of whom had concomitant bile leaks. Strictures were successfully treated with endoscopic balloon dilation in 12 (71%) of the 17 patients (nasobiliary catheter placement in eight and stent placement in four patients). Bile leak was successfully managed in two of three patients. Biliary casts were removed by endoscopic papillary balloon dilation in eight of nine patients. Five patients with failed endoscopic therapy were converted to percutaneous or surgical intervention. Endoscopic-procedure-related cholangitis developed in one patient. During follow-up with median periods of 10 months (range 2-20 months), four of nine patients without stent placement developed biliary strictures, and these were relieved by additional endoscopic management.


CONCLUSIONS
Endoscopic approach has the potential to be a first-line therapy for the management of biliary complications after LDLT.
Tsujino
Takeshi
T
Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Isayama
Hiroyuki
H
Sugawara
Yasuhiko
Y
Sasaki
Takashi
T
Kogure
Hirofumi
H
Nakai
Yousuke
Y
Yamamoto
Natsuyo
N
Sasahira
Naoki
N
Yamashiki
Noriyo
N
Tada
Minoru
M
Yoshida
Haruhiko
H
Kokudo
Norihiro
N
Kawabe
Takao
T
Makuuchi
Masatoshi
M
Omata
Masao
M
D000328:Adult; D000368:Aged; D001646:Bile; D001649:Bile Duct Diseases / Q000209:etiology* / Q000628:therapy*; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome