title: Comparison of biliary complications in adult living-donor liver transplants performed at two busy transplant centers.
abstract: Adult living-donor liver transplantation (ALDLT) has a high rate of biliary complications. We identified risk factors that correlate with biliary leaks and strictures by combining data from two centers. Records of ALDLT right lobe recipients (n = 156) at two centers between December 1998 and February 2005 were reviewed. Leak rate was analyzed in 144 recipients after we excluded those with hepatic artery thrombosis or death within 30 d of transplant. Stricture rate was also analyzed in 132 recipients after we excluded those with graft survival or follow-up <180 d. Biliary reconstructions were performed using either duct-to-duct (DD) or Roux-en-Y hepaticojejunostomy and were subclassified by anatomic type, number of anastomoses performed, and stent use. Prevalence of a leak and/or a stricture was 39%; 11% of recipients developed both. Single DD anastomoses between the graft right hepatic duct to the recipient common duct had significantly lower incidence of leaks compared to all other anastomotic types. Early leak was predictive of late stricture development (p = 0.006), but recipient demographics, diagnosis, warm ischemia time, anastomosis type, duct number, year of transplant, stent use, and transplant center were not. The results suggest donors with a single right hepatic duct reconstructed to the recipient common bile duct are the most likely to avoid biliary problems after ALDLT.
authors.affiliation: Surgery, Division of Transplantation, Stanford University, Stanford, CA, USA.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Melcher
authors.forename: James J
authors.initials: JJ
authors.lastname: Pomposelli
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Verbesey
authors.forename: Ryan A
authors.initials: RA
authors.lastname: McTaggart
authors.forename: Chris E
authors.initials: CE
authors.lastname: Freise
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Ascher
authors.forename: John P
authors.initials: JP
authors.lastname: Roberts
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Pomfret
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000209:etiology*; D001662:Biliary Tract Surgical Procedures; D002648:Child; D005260:Female; D006084:Graft Rejection; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult