Management of biliary complications following living donor liver transplantation—a single center experience

Abstract

BC still account for a high percentage of morbidity and mortality after LDLT. DD anastomoses are performed more frequently and are feasible in cases with simple biliary anatomy; RYHJ is the gold standard for the reconstruction of multiple bile ducts.

Biliary complications after living donor liver transplantation

“…Multiple tiny bile ducts, which often accompany partial liver grafts, and differential blood supplies to these ducts pose special challenges for LDLT programs 6‐13. Actually, biliary complications cause significant morbidity and mortality rates in both donors and LDLT recipients 14, 15. Here we describe key points related to the prevention and management of biliary complications after LDLT.…”

Hepaticojejunostomy Anastomotic Strictures

“…In this latter setting, it has been recently suggested that duct-to-duct anastomosis (DDA) provided better long-term functional results than HJ [24] without increasing the risk of disease recurrence [25,26], supporting that it should be probably preferred [27,28]. In this latter setting, biliary anastomotic strictures represent the Achilles heel of these procedures with reported rates ranging from 6 to 22 % [29,30]. The occurrence of HJ strictures may be the consequence of: (1) impaired graft quality as evidenced by increased rates of HJ strictures with significant steatotic grafts [31,32] with prolonged cold ischemia time [33] or grafts from donors aged > 50 years [30]; (2) technical factors including biliary anatomical variations [31] requiring > 1 biliary anastomosis [30] and small donor right or left bile ducts; [31]; and (3) postoperative complications, mainly biliary leakage [30,34], hepatic artery thrombosis [35], CMV infection [35], and acute cellular rejection [33].…”

Living Donor Liver Transplantation

“…Stenting with percutaneous transhepatic cholangiography (PTC) or ERCP at the anastomotic site can resolve minor leaks. If the anastomosis is seriously disrupted, surgical revision is the safest approach (Kohler S et al 2009). …”

“…Direct cholangiogram is the gold-standard for diagnosing biliary strictures. Any patient with biliary stenosis, especially with multiple strictures, should be evaluated for HAT (Kohler S et al 2009). Early strictures are often amenable to endoscopic or transhepatic intervention with good long-term results.…”