Endoscopic management of biliary complications after adult living-donor versus deceased-donor liver transplantation.
BACKGROUND
Although data about the incidence and management of biliary complications after deceased-donor liver transplantation (DDLT) are well defined, those pertaining to adult living-donor liver transplantation (LDLT) are conflicting.


METHODS
We retrospectively compared endoscopic retrograde cholangio-pancreatography (ERCP) findings in 30 LDLT vs. 357 DDLT consecutive adult recipients with duct-to-duct biliary reconstruction. LDLT and DDLT recipients were followed up for median durations of 30.5 and 36.0 months after the last ERCP, respectively.


RESULTS
Postoperative biliary complications were more frequently identified at ERCP after LDLT versus DDLT (10/30 [33.3%] vs. 34/357 [9.5%]; P<0.001). Complications mainly consisted of anastomotic biliary strictures (10/30 [33.3%] vs. 27/357 [7.6%]; LDLT vs. DDLT recipients, respectively; P<0.001) and biliary leaks (4/30 [13.3%] vs. 6/357 [1.7%]; LDLT vs. DDLT recipients, respectively; P=0.005; some patients had both complications). Stricture dilation was successful in 4/10 (40%) LDLT vs. 27/27 (100%) DDLT recipients (P<0.001), and bile ducts remained patent up to the end of follow-up without further intervention in 2/10 (20.0%) vs. 21/27 (77.8%) patients, respectively (P=0.002). Endoscopic treatment of bile leaks was successful in 3/4 (75.0%) vs. 5/6 (83.3%) LDLT versus DDLT recipients, respectively (NS).


CONCLUSIONS
Biliary complications were more frequent after LDLT compared with DDLT. Endoscopic treatment of anastomotic biliary strictures was successful in a minority of patients after LDLT, in contrast with DDLT. Most biliary leaks were successfully treated at endoscopy after LDLT or DDLT.
Gómez
Carlos Macías
CM
Gastrointestinal Endoscopy Unit, Gastroenterology Service, Italian Hospital, Buenos Aires, Argentina. carlos.macias@hospitalitaliano.org.ar
Dumonceau
Jean-Marc
JM
Marcolongo
Mariano
M
de Santibañes
Eduardo
E
Ciardullo
Miguel
M
Pekolj
Juan
J
Palavecino
Martín
M
Gadano
Adrian
A
Dávolos
Jorge
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001658:Biliary Fistula / Q000209:etiology / Q000601:surgery; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult