Biliary Reconstruction and Complications in Adult-to-Adult Living Donor Liver Transplantation / 대한이식학회지

ABSTRACT

PURPOSE: Biliary complication (BC) is known as the most common and intractable complication after adult living donor liver transplantation (LDLT), but there is lack of large-volume studies with long-term follow-up. To assess the patterns of BC and their treatment results in adult recipients of LDLT. METHODS: 182 adult patients who received 156 right and 26 left liver grafts from January 2001 to December 2002 were selected after exclusion of dual-graft LDLT and short-term survivors. Methods of biliary reconstruction, types of BC, and treatment results of BC were analyzed. RESULTS: The median follow-up period was 38 months. Biliary reconstruction was done as single duct-to-duct anastomosis (DD, n=109), double DD (n=22), single hepaticojejunostomy (HJ, n=31), double HJ (n=16), and combination of DD and HJ (n=4). Overall patient or graft survival rate was 96.2% at 1 year and 93.3% at 3 years. BC-free survival rate was 83.4% at 1 year and 76.5% at 3 years. BC occurred much more often in right liver grafts. There were no statistical differences of BC between DD and HJ groups, and between single and double anastomoses groups. Most of anastomotic leak occurred during the first 1 month, but anastomotic stenosis occurred till 3 years. Small right graft duct around 3 mm in diameter became a significant risk factor of BC. Anastomotic leak occurred in 8 recipients, and 7 recovered after radiological, endoscopic, and surgical treatments. Anastomotic stenosis occurred in 34, and most of them were resolved by radiological intervention. CONCLUSION: The incidence of early BC could be reduced to below 10% by technical refinements, but additional late BC occurred till 3 years. Most of BC were successfully controlled by endoscopic and radiological treatments. DD seems to be avoided in small graft duct around 3 mm in diameter. Close surveillance for BC seems to be mandatory for the first 3 years.