DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20183639

Incidence of biliary complications in living donor liver transplantation

Joseph Varghese

Abstract


Background: Liver transplantation is a widely accepted treatment for end stage liver diseases and selected cases of hepatocellular carcinoma, if it is limited to the liver. Biliary complications such as biliary strictures and bile leaks after the liver transplantation remain the major cause for morbidity and mortality. This study was aimed to estimate the incidence of biliary complications in live donor liver transplantation (LDLT) patients and the rate of radiological intervention in its management.

Methods: Case records of LDLT patients during the past two years were retrospectively studied to estimate the incidence of biliary complications. Biliary complications were diagnosed based on clinical features like pain, fever, jaundice or increased bile from biliary drains. The patients were imaged using ultrasonogram, computed tomogram, magnetic resonance imaging or Endoscopic retrograde cholangiopancreatography (ERCP) for any biliary strictures and leaks, choledocholithiasis or sphincter of oddi dysfunction. The rate of ERCP and Percutaneous Trans Biliary Drainage (PTBD) interventions in these patients was recorded.

Results: Fifty cases of post LDLT patients (both prospective and retrospective) were analysed in the study. The incidence of biliary stricture was 12% (6/50) and among the 6 patients with biliary stricture, 4 had bile leak. Among the total cases, the incidence of biliary leak was 8%. Eighty three percent of the biliary complications were managed by ERCP, whilst 17% by PTBD.

Conclusions: The incidence of biliary stricture was 12% and biliary leak was 8%. The biliary complications were managed by ERCP in 83% and percutaneous approach in 17% of cases.


Keywords


Bilioma, Biliary stricture, Biliary complications, Hepatocellular carcinoma, Liver transplantation, Living donor liver transplantation

Full Text:

PDF

References


Giacomoni A, Lauterio A, Slim AO, Vanzulli A, Calcagno A, Mangoni I, et al. Biliary complications after living donor adult liver transplantation. Transpl Int. 2006;19:466-73.

Gondolesi GE, Varotti G, Florman SS, Muñoz L, Fishbein TM, Emre SH, et al. Biliary stricture and leakage are common complications Biliary complications in 96 consecutive right lobe living donor transplant recipients. Transpl. 2004;77:1842-8.

Seehofer D, Eurich D, Veltzke-Schlieker W, Neuhaus P. Biliary complications after liver transplantation: old problems and new challenges. Am J Transpl. 2013;13:253-65.

Rao HB, Prakash A, Sudhindran S, Venu RP. Biliary strictures complicating living donor liver transplantation: Problems, novel insights and solutions. World J Gastroenterol. 2018;24:2061-72.

Chang JH, Lee I, Choi MG, Han SW. Cutrrent diagnosis and treatment of benign biliary stricture after living donor liver transplantation. World J Gastroenterol. 2016;22:1593-606.

Hsieh TH, Mekeel KL, Crowell MD, Nguyen CC, Das A, Aqel BA, et al. Endoscopic treatment of anastomotic biliary strictures after living donor liver transplantation: outcomes after maximal stent therapy. Gastrointest Endosc. 2013;77:47-54.

Sugawara Y, Makuunchi M. Living donor liver transplantation: present status and recent advances. Br Med Bull. 2005;76;15-28.

Krok KL, Cárdenas A, Thuluvath PJ. Endoscopic management of biliary complications after liver transplantation. Clin Liver Dis. 2010;14:359-71.

Sharma S, Gurakar A, Camci C, Jabbour N. Avoiding pitfalls: what an endoscopist should know in liver transplantation-part II. Dig Dis Sci. 2009;54:1386-402.

Akamatsu H, Sugawara Y, Hashimoto D. Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: a systematic review of the incidence, risk factors and outcome. Transpl Int. 2011;24:379-92.

Li C, Li C, Wen T. Biliary variations and biliary complications in Live Donor Liver Transplantation. Hepatogastroenterology. 2012;59:1526-8.

Ayoub W, Esquivel C, Martin P. Biliary Complications Following Liver Transplantation. Dig Dis Sci. 2010;55:1540-6.

Sheung C, Fan T. Biliary complications of living donor liver transplantation. Hepatol Int. 2008;2:399-404.