Biliary Complications after Duct‐to‐duct Biliary Reconstruction in Living‐donor Liver Transplantation: Causes and Treatment

Abstract

Steroid-sparing basiliximab-based immunosuppressive therapy reduced the incidence of biliary leakage, and biliary leakage was the independent factor for biliary stricture. The non-surgical and surgical treatments for biliary complications were satisfactory.

Endoscopic Management of Biliary Complications After Liver Transplantation

“…Although endoscopic therapy is considered as first line in management of non-anastomotic strictures and may occasionally be a definite solution in selected patients, it requires lifelong surveillance since strictures are likely to recur, and more importantly, it seems to play a prominent role as a bridge to liver retransplantation. A stricture that is too tight precluding successful cannulation of biliary system by the guidewire is the commonest cause of endoscopic failure in management of biliary strictures after LDLT (Tashiro et al, 2007;Verdonk et al, 2007). However, once a stricture is cannulated, the reported success for this procedure is about 80%-90%, which highlights the importance of cannulation of the stricture as a critical event in predicting the success or failure of the endoscopic treatment.…”

“…Inability to cannulate the stricture Tashiro et al, 2007) and difficulty to place a stent (Tsujino et al, 2006) were found to be the most common reasons for the failure of endoscopic treatment in this group of patients. The difference in outcome might be explained by the presence of multiple ductal anastomosis, smaller size, peripheral location, and increased risk of devascularization (Sharma et al, 2008).…”

“…The difference in outcome might be explained by the presence of multiple ductal anastomosis, smaller size, peripheral location, and increased risk of devascularization (Sharma et al, 2008). However, as in DDLT, the combination of balloon dilatation and stenting was superior to either modality alone (Tashiro et al, 2007). Kyoto group classified the strictures in living donor liver transplants into four types: unbranched, fork-shaped, trident-shaped, and multibranched .…”

Management issues in post living donor liver transplant biliary strictures

“…Stents placed for longer time are more likely to get blocked predisposing to cholangitis [37][38][39] . Use of multiple stents has shown better long-term success than single stents [40,41] . There are 4 published trials comparing stenting alone vs stenting and balloon dilatation.…”

Duct-to-Duct Biliary Reconstructions and Complications in 100 Living Donor Liver Transplantations

“…Incidences of up to 40% have been reported for long-term biliary complications among duct-to-duct biliary reconstructions in right or left lobe LDLT. [1][2][3][4] Biliary stricture and leakage at the anastomotic site are major concerns since they are strongly associated with surgical techniques of bile duct preparation and anastomosis.…”