Biliary complications in 108 consecutive recipients with duct-to-duct biliary reconstruction in living-donor liver transplantation.
BACKGROUND
Biliary complications remain the leading cause of postoperative complications after living-donor liver transplantation (LDLT) in patients undergoing duct-to-duct choledochocholedochostomy. The aim of this study was to analyze the causes of these complications.


METHODS
One hundred eight patients who underwent LDLT with duct-to-duct biliary reconstruction at Mie University Hospital were enrolled in this study. The mean follow-up time was 58.4 months (range, 3-132). The most recent 18 donors underwent indocyanine green (ICG) fluorescence cholangiography for donor hepatectomy. The development of biliary complications was retrospectively analyzed. Biliary complications were defined as needing endoscopic or radiologic treatment.


RESULTS
Biliary leakages and strictures occurred in 6 (5.6%) and 15 (13.9%) of the recipients, respectively, and 3 donors (2.7%) experienced biliary leakage. However, since the introduction of ICG fluorescence cholangiography, we have not encountered any biliary complications in either donors or recipients. Biliary leakage was an independent risk factor for the development of biliary stricture (P = .013). Twelve (80%) of the 15 recipients with biliary stricture had successful nonoperative endoscopic or radiologic management, and 3 patients underwent surgical repair with hepaticojejunosotomy.


CONCLUSIONS
Biliary leakage was an independent factor for biliary stricture. ICG fluorescence cholangiography might be helpful to reduce biliary complications after LDLT in both donors and recipients.
Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan. Electronic address: mizunos@clin.medic.mie-u.ac.jp.
S
S
Mizuno
Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Mie, Japan.
H
H
Inoue
Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
A
A
Tanemura
Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
Y
Y
Murata
Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
N
N
Kuriyama
Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
Y
Y
Azumi
Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
M
M
Kishiwada
Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
M
M
Usui
Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
H
H
Sakurai
Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
M
M
Tabata
Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Mie, Japan.
R
R
Yamada
Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Mie, Japan.
N
N
Yamamoto
Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Mie, Japan.
K
K
Sugimoto
Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Mie, Japan.
K
K
Shiraki
Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Mie, Japan.
Y
Y
Takei
Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
S
S
Isaji
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000601:surgery*; D001660:Biliary Tract Diseases / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D055815:Young Adult