Biliary complications in recipients of living-donor liver transplantation

Takatsuki, Mitsuhisa; Eguchi, Susumu; Kawashita, Yujo; Kanematsu, Takashi

doi:10.1007/s00534-005-1082-0

Cited by 30 publications

(25 citation statements)

References 33 publications

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“…As a team, we have succeeded in reducing the operative time, and blood loss, and consequently, the hospital stay after LDLT. Furthermore, the operative technique has been adapted based on updated information from the world literature; for example in relation to the reconstruction of tributaries of the middle hepatic vein, [6][7][8] or bile duct assessment in the donor [9][10][11] Interestingly, because of the broader indications for LDLT, which include HCC rather than end-stage liver cirrhosis in the latter period, the MELD score of the recipients has become lower than in the former period, which might be a contributing factor to the lower blood loss during surgery.…”

Section: Discussionmentioning

confidence: 99%

Evolution of living donor liver transplantation over 10 years: Experience of a single center

et al. 2008

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EGUCHI et al. 2 AbstractPurpose. To evaluate the changes in living donor liver transplantations (LDLTs) over the last 10 years, we analyzed our experience of performing LDLT in a single center. introduced, primarily for hepatocellular carcinoma (HCC) in liver cirrhosis. We also began performing LDLTs for adults with ABO-incompatible blood type combination in the latter period. As the number of adult-to-adult LDLTs increased, left-sided grafts became first choice for these patients. Survival rates were 88.3%, 77.2%, 70.2% at 1, 3 and 5 years respectively. There was a relatively low incidence of arterial complications, and although the incidence of biliary complications was high initially, it decreased with experience. Likewise, the operative time, blood loss, and hospital stay after LDLT also improved remarkably. Methods and Conclusion.Over the last 10 years, the indications for, and operative techniques used in LDLT have changed dramatically, even in a single center in Japan. EGUCHI et al. 3

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Section: Discussionmentioning

confidence: 99%

Evolution of living donor liver transplantation over 10 years: Experience of a single center

et al. 2008

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“…Methods of treatment and success rates of long term endoscopic intervention therapy are difficult to interpret because of the presence of multiple ductal anastomoses, smaller size, peripheral location and increase risk for devascularization [51][52][53] . To date, only 6 published trials have evaluated the efficacy of endoscopic therapy in anastomotic strictures after living donor OLT [24,30,35,52,84,87,91] . Endoscopic treatment success rates appear significantly less than for anastomotic strictures in deceased donor OLT at 60%-75% [52,84,87,91] .…”

Section: Living Donor Liver Transplantation Associated Biliary Strictmentioning

confidence: 99%

Endoscopic management of biliary strictures after liver transplantation

Williams¹,

Draganov²

2009

WJG

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Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Biliary strictures are classified as anastomotic or non-anastomotic strictures according to location and are defined by distinct clinical behaviors. Anastomotic strictures are localized and short. The outcome of endoscopic treatment for anastomotic strictures is excellent. Nonanastomotic strictures often result from ischemic and immunological events, occur earlier and are usually multiple and longer. They are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and need for retransplantation. Living donor OLT patients present a unique set of challenges arising from technical factors, and stricture risk for both recipients and donors. Endoscopic treatment of living donor OLT patients is less promising. Current endoscopic strategies for biliary strictures after OLT include repeated balloon dilations and placement of multiple side-by-side plastic stents. Lifelong surveillance is required in all types of strictures. Despite improvements in incidence and long term outcomes with endoscopic management, and a reduced need for surgical treatment, the impact of strictures on patients after OLT is significant. Future considerations include new endoscopic technologies and improved stents, which could potentially allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. This review focuses on the role of endoscopy in biliary strictures, one of the most common biliary complications after OLT.

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“…He presented with bleed through the external wound. CT angiography revealed pseudoaneurysm [16][17][18][19][20]. He was taken up for angioplasty but he had massive haemorrhage and haemodynamic instability leading to emergency laparotomy and ligation of hepatic artery.…”

Section: Haemorrhagementioning

confidence: 99%

When to Re-explore Recipients in LRLT

Selvakumar¹,

Nayeem²

2016

J Gastrointest Dig Syst

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Re-exploration is one of the surgical complications of living donor liver transplantations. Re-explorations are of two types planned and unplanned. Unplanned re-exploration does always mean poor prognosis to the patient outcome? Was the aim of our study? We analysed retrospectively prospectively maintained data from Jan 2011 to August 2013. Total number of transplants done was 793. Total number of re-explorations was 80 in 66 patients. Reexploration rate was 10.08%. Total mortality in our series was 10.5%. Mortality in Re-exploration group was 45.45%. Of the group of patients re-explored patients re-explored for early haemorrhage had better outcomes compared to patients explored for other reasons. Re-explored patients are at higher risk of fungal infections. Patients with multiple bile ducts are at higher risk of re-explorations. Patients re-explored in the immediate post-operative period had better outcomes compared to patients re-explored late. Overall it is a poor prognostic indicator of surgical outcome in living donor liver transplantation.

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Biliary complications in recipients of living-donor liver transplantation

Cited by 30 publications

References 33 publications

Evolution of living donor liver transplantation over 10 years: Experience of a single center

Evolution of living donor liver transplantation over 10 years: Experience of a single center

Endoscopic management of biliary strictures after liver transplantation

When to Re-explore Recipients in LRLT

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