Biliary complications including single-donor mortality: experience of 207 adult-to-adult living donor liver transplantations with right liver grafts.
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.
El-Meteini
Mahmoud
M
Department of Surgery, Ain-Shams University, Ain-Shams University, Cairo, Egypt. mmeteini@idsc.net.eg
Hamza
Alaa
A
Abdalaal
Amr
A
Fathy
Mohamed
M
Bahaa
Mohamed
M
Mukhtar
Ahmed
A
Abouelfetouh
Fawzia
F
Mostafa
Ibrahim
I
Shaker
Mohamed
M
Abdelwahab
Sameh
S
El-Dorry
Ahmed
A
El-Monayeri
Magda
M
Hobballah
Ali
A
Sabry
Hasan
H
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