title: Biliary complications including single-donor mortality: experience of 207 adult-to-adult living donor liver transplantations with right liver grafts.
abstract: BACKGROUND
  After right lobe donation, biliary complication is the main cause of morbidity. Mortality after right lobe donation has been estimated to be less than 0.5%.
  
  
  METHODS
  Between November 2001 and December 2008, 207 adult-to-adult living donor liver transplantations (ALDLT) were undertaken using right lobe grafts. Donors included 173 men and 34 women with a mean age of 28.4 +/- 5.2 years.
  
  
  RESULTS
  Siblings comprised 144 (69.6%) cases whereas unrelated donors comprised 63 (30.4%) with a mean body mass index (BMI) of 25.2 +/- 2.4. Single and multiple right hepatic ducts (RHD) were present in 82 (39.6%) and 125 (60.3%) donors, respectively. Mean operative time was 360 +/- 50 min with an estimated blood loss of 950 +/- 450 ml and returned cell-saver amount of 450 +/- 334 ml. Mean donor remnant liver volume was 33.5 +/- 3.2%. Mean intensive care unit (ICU) stay was 3 +/- 0.7 days and mean hospital stay was 14 +/- 3.5 days. Modified Clavien classifications were used to stratify all donor biliary complications The overall biliary complications occurred in 27 cases (13.0%). After modified Clavien classification, biliary complications were graded as grade I (n= 10), grade II (n= 2), grade III (n= 14) and grade V (n= 1). Grade I and II (n= 12) biliary complications were successfully managed conservatively. Grade III cases were treated using ultrasound-guided aspiration (USGA), endoscopic retrograde cholangiography (ERCP) and surgery in 10, 2 and 2 donors, respectively. Single donor mortality (Grade V) (0.4%) occurred after uncontrolled biliary leakage with peritonitis that necessitated exploration followed by ERCP with stent insertion but the donor died on day 43 as a result of ongoing sepsis.
  
  
  CONCLUSIONS
  Although the majority of biliary complications are minor and can be managed conservatively, uncontrolled biliary leakage is a serious morbidity that should be avoided as it could lead to mortality.
authors.affiliation: Department of Surgery, Ain-Shams University, Ain-Shams University, Cairo, Egypt. mmeteini@idsc.net.eg
authors.forename: Mahmoud
authors.initials: M
authors.lastname: El-Meteini
authors.forename: Alaa
authors.initials: A
authors.lastname: Hamza
authors.forename: Amr
authors.initials: A
authors.lastname: Abdalaal
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fathy
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bahaa
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mukhtar
authors.forename: Fawzia
authors.initials: F
authors.lastname: Abouelfetouh
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Mostafa
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shaker
authors.forename: Sameh
authors.initials: S
authors.lastname: Abdelwahab
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Dorry
authors.forename: Magda
authors.initials: M
authors.lastname: El-Monayeri
authors.forename: Ali
authors.initials: A
authors.lastname: Hobballah
authors.forename: Hasan
authors.initials: H
authors.lastname: Sabry
mesh_terms: D000293:Adolescent; D000328:Adult; D001660:Biliary Tract Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016063:Blood Loss, Surgical; D001804:Blood Transfusion, Autologous; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003422:Critical Care; D004534:Egypt; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012720:Severity of Illness Index; D035781:Siblings; D013396:Suction; D013997:Time Factors; D018084:Ultrasonography, Interventional; D055815:Young Adult