Biliary complications in donors for living donor liver transplantation.
OBJECTIVE
With the increasing number of living donor liver transplantations, biliary complications in donors have emerged as a major postoperative problem. The aim of the present study was to characterize the features of the biliary complications that occur in donors.


METHODS
The study subjects comprised 731 consecutive patients who donated liver grafts (434 right-lobe and 297 left-lobe grafts) for transplantation at Kyoto University Hospital from July 1999 to December 2006. Donors whose biliary complications could not be cured by conservative therapy were referred for endoscopic treatment.


RESULTS
Postoperative biliary complications occurred in 55 (7.5%) donors. Initially, 48 of these 55 donors had biliary leakage and 7 had biliary stricture. Subsequently, 5 of 48 donors with leakage developed biliary stricture. The respective incidences of biliary leakage and overall biliary complications were significantly higher among donors of right-lobe grafts (9.9% and 11.1%) than among donors of left-lobe grafts (1.7% and 2.4%). Among 55 donors with biliary complications, 24 were cured by conservative therapy, and 1 was converted to surgical repair due to ileus. Endoscopic treatment was successful in 24 of 30 (80%) donors treated by endoscopic retrograde cholangiography, while the remaining 6 (20%) patients underwent surgery due to difficulties with cannulation (N = 2), excessive biliary leakage (N = 2), or complete biliary obstruction (N = 2).


CONCLUSIONS
Donors of right-lobe grafts have a significantly higher incidence of biliary complications than donors of left-lobe grafts. When conservative therapy fails, endoscopic treatment is effective for these complications, and should be attempted as the first-line therapy before surgical repair.
Shio
Seiji
S
Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Yazumi
Shujiro
S
Ogawa
Kohei
K
Hasegawa
Kazunori
K
Tsuji
Yoshihisa
Y
Kida
Masaya
M
Yamauchi
Junichi
J
Ida
Hiroshi
H
Tada
Shinsuke
S
Uemoto
Shinji
S
Chiba
Tsutomu
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D015331:Cohort Studies; D004724:Endoscopy; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D016896:Treatment Outcome