Biliary strictures in living donor liver transplantation: Incidence, management, and technical evolution

Abstract

Biliary complications, biliary strictures (BS) in particular, continue to be a significant cause of morbidity after LDLT despite technical refinement. In this study, we assessed the incidence of BS and their management in living donor liver transplantation (LDLT) with special reference to the type of biliary reconstruction. A total of 182 LDLTs performed at our institution for either adult (n ‫؍‬ 157) or pediatric (n ‫؍‬ 25) patients were included in the study. The duct-to-duct (DD) biliary reconstruction was performed for 106 cases, while the conventional Roux-en-Y hepaticojejunostomy (HJ) was utilized for the remaining 76 cases. Overall, BS developed in 46/182 (25.3%) of the cases (DD, 26.4%; HJ, 25.0%). The 1-and 3-year cumulative incidences of BS were 22.9% and 31.9%, respectively, in the DD group, and 15.2% and 29.1%, respectively, in the HJ group (P ‫؍‬ not significant). The left-lobe LDLT was more prone to develop BS. Continuous anastomosis tended to be associated with the high incidence of BS in the DD group. The incidence of anastomotic leak was significantly lower in the DD group. Intervention via either precutaneous or endoscopic approach was successful in the majority of cases, although recurrence could occur in some patients. In conclusion, BS was not associated with the type of reconstruction in LDLT. The primary radiological or endoscopic interventions were satisfactory treatments of choice. Technical refinement is an important factor to reduce the incidence of BS. Liver Transpl 12:979-986, 2006.

Liver transplantation in Indian Armed Forces—initial experience

“…[3][4][5][6][7][8][9][10][11][12].8% in studies published after 2008 (Table 6). [27][28][29][30][31][32][33][34] Overall biliary complications in LDLT in our series was seen in three recipients (16.6%) which compares well with other studies. Aberrant biliary anatomy or two or more ducts have been proved to be a significant risk factor for the development of biliary complications.…”

Endoscopic management of biliary strictures after living donor liver transplantation

“…While identification of the causative factors of biliary complications and subsequent refinements in reconstruction techniques might reduce the incidence of these complications in some institutions [20][21][22], the rate of biliary complications, particularly biliary strictures, does not seem to significantly decrease with experience [7,8,19,23]. Kyoto University divided LDLT recipients into three groups according to case experience (Group 1, cases 1-100; Group 2, cases 101-200; and Group 3, cases 201-335), and found that while the rate of bile leakage significantly decreased with experience (25% in Group 1, 14% in Group 2, and 13% in Group 3, p = 0.021), there were no differences in the development of biliary strictures among the three groups (19,28, 26%, respectively, p = 0.290) [7].…”

When to Re-explore Recipients in LRLT

“…The increased use of split livers in the United States and Europe also contributed to the surgical skills needed to successfully perform the LDLT procedure. Unlike living donor kidney transplantation, where advantages of living donor over deceased donor grafts have been demonstrated in both recipient and graft survival, and where the safety of the donor operation has been documented, LDLT is still under a high level of scrutiny [30][31][32][33].…”