Biliary complications after right lobe living donor liver transplantation: a single-centre experience

Yaprak, Onur; Dayangaç, Murat; Akyıldız, Murat; Demirbas, Tolga; Guler, Necdet; Bulutcu, Fisun; Başsüllü, Nuray; Akun, E.; Yüzer, Yıldıray; Tokat, Yaman

doi:10.1111/j.1477-2574.2011.00401.x

Cited by 28 publications

(23 citation statements)

References 13 publications

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“…Living-donor and DCD grafts are at significantly higher risk for biliary complications. [36][37][38][39][40][41] In our series, the overall bile leak rate was 11.6% and the overall biliary stricture rate was 16.4%. When we evaluated the subgroups, the highest rates were observed in the adult LDLT group, with a bile leak rate 13.1% and a biliary stricture rate 23.6% (Table 4).…”

Section: Discussionmentioning

confidence: 47%

Untitled

Yankol

Mecit²,

Kanmaz³

et al. 2016

Exp Clin Transplant

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Objectives: We present here the outcomes of our first 500 liver transplants and discuss the lessons learned during this time. The main cause of chronic liver failure was biliary atresia in pediatric patients (30.4%) and chronic hepatitis B infection in adults (35.6%). The complication rate for primary nonfunction was 3.8%, overall biliary complications 24.0% (significantly higher after adult living-donor liver transplant, 30.3%), hepatic artery thrombosis 1.6%, portal vein thrombosis 3.0%, retransplant 3.8%, acute cellular rejection 29.6%, and bacterial infection 39.4%. Overall 1-, 3-, and 5-year patient survival rates in the first 500 consecutive transplants performed on recipients within United Network for Organ Sharing listing criteria were 87.8%, 85.0%, and 78.6%; for hepatocellular carcinoma patients beyond the Milan criteria, survival rates were 71.9%, 52.5%, and 38.2%. Conclusions:In regions without a sufficient number of deceased donors, living-donor liver transplant, with its associated problems, is the only alternative to deceased-donor liver transplant. Liver transplant requires teamwork, with all players working well together for a successful outcome. The important keys to success in liver transplant include decision-making, timing, surgical skills, experience, and close follow-up.

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Section: Discussionmentioning

confidence: 47%

Untitled

Yankol

Mecit²,

Kanmaz³

et al. 2016

Exp Clin Transplant

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“…However, the studies about the clinical manifestations, complications, and mortality based on the type of donor reported many different results. Some studies reported similar biliary complications between LDLT and deceased donor liver transplantation (DDLT) (34). Quintini et al (5) found that LDLT is safe and, in select cases, offers advantages over DDLT.…”

Section: Introductionmentioning

confidence: 99%

Clinical Impacts of Donor Types of Living vs. Deceased Donors: Predictors of One-Year Mortality in Patients with Liver Transplantation

et al. 2017

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Transplantation studies about the clinical differences according to the type of donors are mostly conducted in western countries with rare reports from Asians. The aims of this study were to evaluate the clinical impacts of the type of donor, and the predictors of 1-year mortality in patients who underwent liver transplantation (LT). This study was performed for liver transplant recipients between May 2010 and December 2014 at the Pusan National University Yangsan Hospital. A total of 185 recipients who underwent LT were analyzed. Of the 185 recipients, 109 (58.9%) belonged to the living donor liver transplantation (LDLT) group. The median age was 52.4 years. LDLT recipients had lower model for end-stage liver disease (MELD) score compared with better liver function than deceased donor liver transplantation (DDLT) recipients (mean ± standard deviation [SD], 12.5 ± 8.3 vs. 24.9 ± 11.7, respectively; P < 0.001), and had more advanced hepatocellular carcinoma (HCC) (62.4% vs. 21.1%, respectively; P = 0.001). In complications and clinical outcomes, LDLT recipients showed shorter stay in intensive care unit (ICU) (mean ± SD, 10.8 ± 8.8 vs. 23.0 ± 13.8 days, respectively, P < 0.001), ventilator care days, and post-operative admission days, and lower 1-year mortality (11% vs. 27.6%, respectively, P = 0.004). Bleeding and infectious complications were less in LDLT recipients. Recipients with DDLT (P = 0.004) showed higher mortality in univariate analysis, and multi-logistic regression analysis found higher MELD score and higher pre-operative serum brain natriuretic peptide (BNP) were associated with 1-year mortality. This study may guide improved management before and after LT from donor selection to post-operation follow up.

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“…So far, it remains unclear whether using a living donor (LD) graft with multiple BDs increases the risk for the development of postoperative anastomotic biliary complications or even graft loss. Although some groups reported an increased complication rate using LD grafts with multiple BDs, others did not find an association between the development of biliary strictures and the number of BDs …”

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confidence: 96%

Living Donor Liver Transplantation Using Selected Grafts With 2 Bile Ducts Compared With 1 Bile Duct Does Not Impact Patient Outcome

Kollmann¹,

Goldaracena²,

Sapisochín³

et al. 2018

Liver Transpl

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The outcome after living donor liver transplantation (LDLT) using grafts with multiple bile ducts (BDs) remains unclear. We analyzed 510 patients who received an adult‐to‐adult right lobe LDLT between 2000 and 2015 and compared outcome parameters of those receiving grafts with 2 BDs (n = 169) with patients receiving grafts with 1 BD (n = 320). Additionally, patients receiving a graft with 3 BDs (n = 21) were analyzed. Demographic variables and disease severity were similar between the groups. Roux‐en‐Y reconstruction was significantly more common in the 2 BD group (77% versus 38%; P < 0.001) compared with the 1 BD group. No difference was found in biliary complication rates within 1 year after LDLT (1 BD versus 2 BD groups, 18% versus 21%, respectively; P = 0.46). In the 2 BD group, 82/169 (48.5%) patients were reconstructed with 2 anastomoses. The number of anastomoses did not negatively impact biliary complication rates. Recipients’ major complication rate (Clavien ≥ 3b) was similar between both groups (1 BD versus 2 BD groups, 21% versus 24%, respectively; P = 0.36). Furthermore, no difference could be found between the 1 BD, the 2 BD, and the 3 BD groups in the frequency of developing biliary complications within 1 year (18%, 21%, 14%, respectively; P = 0.64), BD strictures (15%, 15%, 5%, respectively; P = 0.42), or BD leaks (10%, 11%, 10%, respectively; P = 0.98). In addition, the 1‐year (90% versus 91%), 5‐year (82% versus 77%), and 10‐year (70% versus 66%) graft survival rates as well as the 1‐year (92% versus 93%), 5‐year (84% versus 80%), and 10‐year (75% versus 76%) patient survival rates were comparable between the 1 BD and the 2 BD groups (P = 0.41 and P = 0.54, respectively). In conclusion, this study demonstrates that selected living donor grafts with 2 BDs can be used safely without negatively impacting biliary complication rates and graft or patient survival rates.

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Biliary complications after right lobe living donor liver transplantation: a single-centre experience

Abstract: Identification of more than one biliary orifice in the graft resulted in an increase in the complication rates. In grafts containing multiple orifices, performing multiple duct-to-duct (DD) or Roux-en-Y anastomoses led to a lower number of complications.

Cited by 28 publications

References 13 publications

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Clinical Impacts of Donor Types of Living vs. Deceased Donors: Predictors of One-Year Mortality in Patients with Liver Transplantation

Living Donor Liver Transplantation Using Selected Grafts With 2 Bile Ducts Compared With 1 Bile Duct Does Not Impact Patient Outcome

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