Bile leak following living donor liver transplantation: Clinical efficacy of percutaneous transhepatic treatment

Abstract

Percutaneous transhepatic treatment may be effective in patients with bile leaks after living donor liver transplantation (LDLT). We therefore evaluated the clinical efficacy of percutaneous transhepatic treatment for biliary leaks in adult-to-adult LDLT recipients. Twenty-three LDLT recipients underwent percutaneous transhepatic treatment to manage bile leaks. The treatment included percutaneous transhepatic biliary drainage (PTBD) and drainage of perihepatic biloma. In patients with combined biliary strictures, balloon dilation was usually performed. Indications for PTBD included patients who had a Roux-en-Y hepaticojejunostomy (n ϭ 9), failed endoscopic cannulation of bile ducts (n ϭ 6), a bile leak refractory to endoscopic management (n ϭ 5), and a poor general condition for endoscopic management (n ϭ 3). Clinical success was achieved in 16 of 23 (70%) patients. PTBD catheters were removed from 14 of the 16 patients with clinical success at a median of 8 months (range, 3-42 months) after initial PTBD. Aside from 1 patient with intrahepatic pseudoaneurysms, there were no major complications. During a median follow-up period of 42 months (range, 3.0-84 months), 6 (43%) of the 14 patients who underwent PTBD catheter removal experienced jaundice or cholangitis due to biliary anastomotic stricture at a median of 26 months (range, 22-49 months) after PTBD catheter removal. In conclusion, percutaneous transhepatic treatment for biliary leaks in adult-to-adult LDLT recipients is clinically effective. This approach is a valuable alternative for treating bile leaks Bile leaks are an important cause of morbidity and mortality following living donor liver transplantation (LDLT) and usually require therapy, including percutaneous interventions, endoscopic management, and reoperations. 1 Endoscopic treatment has largely replaced reoperation as the initial treatment of bile leaks in patients who have previously undergone duct-to-duct (D-D) biliary reconstruction. 2,3 However, endoscopic treatment is difficult in patients who have previously undergone Roux-en-Y hepaticojejunostomy (RYHJ). In addition, endoscopic cannulation of the ampulla of Vater or tight biliary strictures is often difficult or even impossible. 2 In such situations, percutaneous transhepatic treatment may be a good alternative.We therefore retrospectively evaluated the clinical efficacy of percutaneous transhepatic treatment in patients who had bile leaks following adult-to-adult LDLT. PATIENTS AND METHODS Patient PopulationFrom May 1999 to July 2005, bile leaks occurred in 46 (5.4%) of 856 patients who underwent adult-to-adult LDLT at our institution. Of 46 patients, 12 patients underwent endoscopic nasobiliary drainage, 9 underwent percutaneous drainage of biloma only, 2 underwent surgical repair, and the remaining 23 patients

Endoscopic management of biliary strictures after liver transplantation

“…A subset of patients with a sharp angulation or "crane neck" deformity of the bile duct may make strictures resistant to endoscopic treatment [53] . Percutaneous transhepatic therapy appears safe and effective when ERCP fails [53,92,93] . Non-anastomotic strictures in living donor OLT have even lower success rates ranging from 25% to 33%, significantly below the 50%-75% seen in patients with deceased donor OLT [31,52,53,92,93] .…”

“…Percutaneous transhepatic therapy appears safe and effective when ERCP fails [53,92,93] . Non-anastomotic strictures in living donor OLT have even lower success rates ranging from 25% to 33%, significantly below the 50%-75% seen in patients with deceased donor OLT [31,52,53,92,93] . Overall, surgical revision is carried out more frequently in recipients after living donor OLT than after deceased donor OLT [87] .…”

Short- and Long-Term Outcome of Balloon Dilatation of Benign Biliary Strictures

“…In these patients, percutaneous trans-hepatic biliary drainage (PTBD) has been shown to be a successful method in the treatment of biliary leakage (14)(15)(16). The combination of PTBD and balloon dilation offers a less invasive approach.…”

Role of interventional radiology in the management of complications after pancreatic surgery: a pictorial review

“…Although in recent years refinements in surgical technique and perioperative management have led to a reduction in perioperative mortality, the incidence of postoperative complications (including intra-abdominal abscesses and leakages [4][5][6][7][8][9], biliary complications [10][11][12][13][14] and vascular complications [15][16][17][18]) still remains high. Moreover, in case of complications, surgical re-operation is associated with a high mortality rate [1][2][3].…”

“…Several different IR procedures, such as percutaneous drainage, aspiration of abscesses or fluid collections [4,5], percutaneous transhepatic biliary drainage [6], and arterial embolisation [21][22][23] have been introduced in clinical practice to treat post-surgical complications. IR procedures are an alternative approach to manage post-surgical complications less invasive than surgical re-intervention, and may lead to a reduction in hospital stay and re-operation rate [10,11].…”