[Prevention and treatment of biliary tract complications following adult living donor liver transplantation].
OBJECTIVE
To investigate the prevention and treatment of biliary tract complications following adult-adult living donor liver transplantation (A-A LDLT).


METHODS
One hundred and eight patients, aged 38 (18 - 63), underwent A-A LDLT, including transplantation of the right liver graft without middle hepatic vein (MHV) in 102 cases and dual graft transplantation in 6 cases (of left lobe from relative in 1 case, of right lobe+left lobe from relative in 3 cases, of right lobe from relative + cadaveric left lobe in 2 cases). Preoperative 3-dimensional computerized tomography (3D CT) and intra-operative cholangiography were employed to reveal the state of the liver, caution was exercised to protect the peripheral vasculature of the right hepatic duct during resection. The bile duct was reconstructed by duct-to-duct (D-D) biliary anastomosis or Roux-en-Y anastomosis of the hepatic duct and jejunum (H-J).


RESULTS
Twenty-four of the 108 patients (22.2%) suffered from complications, including bile leakage (n = 4), cutting surface bile leakage (n = 1), and anastomotic biliary stricture (n = 3), etc. Seven donors (6.3%) suffered from complications too, including 2 cases of bile leakage from the remnant cut surface. All the biliary tract complications were properly managed with good outcomes, except for 1 case of recipient death.


CONCLUSIONS
Measures such as improvement of pre- and intra-surgical examinations and assessments, choice of appropriate approach of biliary tract reconstruction, employment of subtle operations of microscopic procedures, and timely detection and management of complications may reduce the incidence and mortality of biliary tract complications following A-A LDLT.
Xia
Tian
T
Centre for Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China. xisummer@tom.con
Yan
Lü-Nan
LN
Li
Bo
B
Zeng
Yong
Y
Wen
Tian-Fu
TF
Zhao
Ji-Chun
JC
Wang
Wen-Tao
WT
Yang
Jia-Yin
JY
Xu
Ming-Qing
MQ
Ma
Yu-Kui
YK
Chen
Zhe-Yu
ZY
Wu
Hong
H
D000293:Adolescent; D000328:Adult; D001660:Biliary Tract Diseases / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies