Biliary complications after duct-to-duct biliary reconstruction in living-donor liver transplantation: causes and treatment.
BACKGROUND
In living-donor liver transplantation (LDLT), biliary complications are recognized as a significant cause of post-transplantation morbidity.


METHODS
Eighty patients who underwent LDLT with duct-to-duct biliary reconstruction at Hiroshima University Hospital were enrolled in this study. The mean follow-up was 24 months (range, 3-72 months). Eighteen patients underwent the basiliximab-based immunosuppressive therapy, and 62 patients underwent non-basiliximab-based immunosuppressive therapy. The development of biliary complications after LDLT was retrospectively analyzed. Biliary complications were initially treated by endoscopic or radiological modalities.


RESULTS
Biliary leakages and strictures occurred in 12 (15%) and 20 (25%) of the 80 patients, respectively. Stepwise multivariate analysis demonstrated bile leakage to be an independent risk factor for the development of biliary stricture (p = 0.001) and basiliximab-based immunosuppressive therapy to be an independent protective factor for postoperative biliary leakage (p = 0.005). The 1-week total doses of steroids were significantly lower in the basiliximab-based immunosuppressive regimes (mean dose: 573 mg) than in the non-basiliximab-based ones (mean dose: 1,121 mg) (p = 0.01). All patients with biliary leakage were successfully treated with endoscopic or radiological modalities, except one patient who was treated by surgical treatment. Endoscopic or radiological modalities were successful as primary treatment modalities in 12 (60%) of 20 patients with biliary strictures. Lastly, six patients were treated surgically with long-term success, except for one patient with chronic cholangitis who died after 16 months.


CONCLUSIONS
Steroid-sparing basiliximab-based immunosuppressive therapy reduced the incidence of biliary leakage, and biliary leakage was the independent factor for biliary stricture. The non-surgical and surgical treatments for biliary complications were satisfactory.
Tashiro
Hirotaka
H
Second Department of Surgery, Hiroshima University, 1-2-3, Kasumi, Hiroshima,734-8551, Japan. htashiro@hiroshima-u.ac.jp
Itamoto
Toshiyuki
T
Sasaki
Tamito
T
Ohdan
Hideki
H
Fudaba
Yasuhiro
Y
Amano
Hironobu
H
Fukuda
Saburo
S
Nakahara
Hideki
H
Ishiyama
Kohei
K
Ohshita
Akihiko
A
Kohashi
Toshihiko
T
Mitsuta
Hiroshi
H
Chayama
Kazuaki
K
Asahara
Toshimasa
T
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077552:Basiliximab; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012307:Risk Factors
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D009173:Mycophenolic Acid