Operative outcomes of adult-to-adult right lobe live donor liver transplantation: A comparative study with cadaveric whole-graft liver transplantation in a single center

Liu, C L; Fan, Sheung Tat; Lo, Chung Mau; Wei, William Ignace; Chan, See Ching; Yong, BH; Lai, CL; Wong, Joyce

doi:10.1097/00007890-200407271-00313

Cited by 46 publications

(71 citation statements)

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“…Biliary strictures occur more frequently after LDLT than after DDLT [12,[27][28][29]. Compared to DDLT, a partial graft has a smaller bile duct diameter and sometimes multiple biliary openings, rendering biliary reconstruction in LDLT complex and technically demanding.…”

Section: Etiologies and Risk Factors For Biliary Strictures After Ldltmentioning

confidence: 99%

“…Other risk factors for BAS identified in multivariate analyses include donor age [50 years [8], preoperative MELD score C35 [27], urgency of the surgery [33], bile duct diameter [34], a graft with multiple bile ducts [31], graft cold ischemia time [24,34], hepatic artery stenosis [31], and acute cellular rejection [24]. Whether the biliary reconstruction technique affects the development of BAS is controversial.…”

Section: Etiologies and Risk Factors For Biliary Strictures After Ldltmentioning

confidence: 99%

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Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

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Section: Etiologies and Risk Factors For Biliary Strictures After Ldltmentioning

confidence: 99%

Section: Etiologies and Risk Factors For Biliary Strictures After Ldltmentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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“…Since the initial cases of living donor liver transplantation (LDLT) were performed (1,2), more than 20 years have already passed and LDLT has become one of the standard therapeutic modalities for patients with end stage liver disease (3)(4)(5)(6) as well as hepatocellular carcinoma (7)(8)(9). The safety of living liver donors is of paramount importance and this issue has been aggressively discussed so far (10)(11)(12)(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Revisiting the Safety of Living Liver Donors by Reassessing 441 Donor Hepatectomies: Is a Larger Hepatectomy Complication-Prone?

Uchiyama

Shirabe

Nakagawara

et al. 2014

American Journal of Transplantation

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“…5 Despite all surgical and technological advances, recipient biliary complications continue to be an important posttransplant issue, including mortality in patients undergoing liver transplant. 6,7 Complications, including those involving bile ducts, are more frequent in living donor transplant procedures using partial grafts than in transplants with deceased donations. [6][7][8] The reported risk factors for biliary complications after anastomosis are rather confusing.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Complications, including those involving bile ducts, are more frequent in living donor transplant procedures using partial grafts than in transplants with deceased donations. [6][7][8] The reported risk factors for biliary complications after anastomosis are rather confusing. Although biliary anatomic variations in donors and surgical techniques are widely acknowledged risk factors for recipient biliary complications, 9,10 it has been reported that donor age, donor body mass index, and macrovacuolar steatosis of the graft may be independent risk factors for biliary complications.…”

Section: Introductionmentioning

confidence: 99%

Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant

Tezcaner¹,

Dinc²,

Karakayalı³

et al. 2019

Exp Clin Transplant

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Objectives: Our aim was to evaluate the influence of the localization of right posterior bile duct anatomy relative to portal vein of the donors on posttransplant bile duct complications. Materials and Methods: We retrospectively investigated 141 patients who had undergone living donor liver transplant using right hemiliver grafts. The patients were classified based on the pattern of the right posterior bile duct and divided into infraportal and supraportal types. Clinical donor and recipient risk factors and surgical outcomes were compared for their relationship with biliary complications using logistic regression analyses. Results: The 2 groups were similar according to demographic and clinical features. The biliary complication rate was 23.7% (9/38) in the infraportal group and 47.4% (37/78) in the supraportal group (P = .014). An analysis of risk factors for the development of anastomotic bile leak using logistic regression showed that a supraportal right posterior bile duct anatomy was a statistically significant positive predictor, with odds ratio of 18.905 (P = .012; confidence interval, 1.922-185.967). The distance of the right posterior bile duct from confluence was significantly lower in patients with biliary complications than in those without (mean of 7.66 vs 0.40 mm; P = .044). According to receiver operating characteristic analyses, the cutoff point for the length of right bile duct to right posterior bile duct from the hepatic confluence was 9.5 mm regarding presence of complications. Conclusions: Factors influencing bile duct anastomosis leakage were supraportal-type donor bile duct anatomy and length of the right main bile duct from biliary confluence. Hepatic arterial complications were similarly a risk factor for biliary strictures. Because of the multiple factors leading to complications in living donor liver transplant, it is challenging to group these patients by operative risk; however, establishing risk models may facilitate the prediction of complications.

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Operative outcomes of adult-to-adult right lobe live donor liver transplantation: A comparative study with cadaveric whole-graft liver transplantation in a single center

Cited by 46 publications

References 0 publications

Endoscopic management of biliary strictures after living donor liver transplantation

Endoscopic management of biliary strictures after living donor liver transplantation

Revisiting the Safety of Living Liver Donors by Reassessing 441 Donor Hepatectomies: Is a Larger Hepatectomy Complication-Prone?

Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant

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