Incidence and management of biliary complications after adult-to-adult living donor liver transplantation.
BACKGROUND
There are few detailed reports of biliary complications in a large adult living donor liver transplantation (LDLT) series.


METHODS
Biliary complications, treatment modalities, and outcomes in these patients were retrospectively analyzed in 310 adult LDLT.


RESULTS
One patient underwent retransplantation. Duct-to-duct anastomosis was primarily performed in 223 patients (72%). During the observation period (median 43 months), biliary complications were observed in 111 patients (36%); 53 patients (17%) had bile leakage, 70 patients (23%) had bile duct stenosis, and 12 patients (4%) had bile leakage followed by stenosis. A biliary anastomotic stent tube was placed in 266 patients (86%) at the time of transplantation. Univariate analysis of various clinical factors revealed duct-to-duct anastomosis as the single significant risk factor (p=0.009) for biliary complications. The three-yr and five-yr overall patient survival rates were 88% and 85% in those with biliary complications, and 85% and 83%, respectively, in those without biliary complications (p=0.59).


CONCLUSIONS
Biliary complications are a major cause of morbidity following LDLT. Duct-to-duct anastomosis carried a higher risk for bile duct stenosis. With appropriate management, however, there was little influence on overall survival.
Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Yusuke
Y
Kyoden
Sumihito
S
Tamura
Yasuhiko
Y
Sugawara
Yuichi
Y
Matsui
Junichi
J
Togashi
Junichi
J
Kaneko
Norihiro
N
Kokudo
Masatoshi
M
Makuuchi
D000293:Adolescent; D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000150:complications* / Q000628:therapy*; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult