title: Outcomes of endo-radiological approach to management of bile leakage after right lobe living donor liver transplantation.
abstract: OBJECTIVE
  Bile leakage is a major complication after right lobe living donor liver transplantation (RLDLT). It can result in significant morbidities and, occasionally, mortalities. Endo-radiology is a non-surgical means that has been used to manage this complication. This study reviews the outcomes of the endo-radiological approach to the management of bile leakage after RLDLT with duct-to-duct anastomosis (DDA) at a high-volume center.
  
  
  METHODS
  A retrospective study was conducted on all adult patients who received RLDLT at our center between January 2001 and December 2013. There were 496 RLDLTs performed during the study period. Only patients who had DDA as the only bile duct reconstruction method were included in the study.
  
  
  RESULTS
  Twelve (3.7%) out of the 328 study subjects developed bile leakage after RLDLT. Six out of these 12 patients were successfully treated with the endo-radiological approach without the need for laparotomy. They had endoscopic retrograde cholangiography with stenting followed by percutaneous drainage of biloma. One of the 12 patients died from recurrence of hepatocellular carcinoma 37 months after transplantation. The remaining 11 patients are all alive.
  
  
  CONCLUSIONS
  The endo-radiological approach should be the first-line management for bile leakage for selected patients with DDA as the bile duct reconstruction method.
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong.
authors.forename: Kenneth S H
authors.initials: KS
authors.lastname: Chok
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong.
authors.forename: Albert C Y
authors.initials: AC
authors.lastname: Chan
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong.
authors.forename: William W
authors.initials: WW
authors.lastname: Sharr
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong.
authors.forename: Tan To
authors.initials: TT
authors.lastname: Cheung
authors.affiliation: Department of Medicine, The University of Hong Kong, Hong Kong.
authors.forename: James Y Y
authors.initials: JY
authors.lastname: Fung
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong.
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.affiliation: Department of Surgery, The University of Hong Kong, Hong Kong.
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000601:surgery*; D001646:Bile; D001652:Bile Ducts / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D004322:Drainage; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: bile leak; biliary anastomotic stricture; biliary reconstruction; endoscopic retrograde cholangiography; liver transplantation; living donor