Abstract No. 557 Does donor anatomy impact biliary interventions in living donor liver transplantation?

Abstract

Biliary intervention on living donor liver transplants (LDLT) is complicated by variant biliary anatomy found during donor harvest which require multiple anastomoses. This study sought to explore the outcomes of percutaneous biliary drainage (PBD) in this unique population. An IRB approved retrospective review of 83 patients undergoing LDLT between 2007 and 2017 was performed. Fourteen of 83 LDLT recipients (median age 56 years; 7 males) had post-transplant biliary complications managed with percutaneous biliary drainage (PBD) and stenting in the setting of failed or contraindicated ERCP. Etiologies of liver disease: hepatitis C (n = 6), primary sclerosing cholangitis (n = 2), primary biliary cirrhosis (n = 2), alcoholic cirrhosis (n = 2), biliary atresia (n = 1), and hemochromatosis (n = 1). Median follow-up was 52 months (range, 6-123 months), and median graft survival was 43 months (range, 2-123 months). Donor cholangiograms were reviewed for Huang classification. PBD was performed due to: biliary stricture (9), biliary leak (1), and biliary stricture with leak (4). Median duration of PBD was 8 months (range, 4-27). Ten of 14 (71%) patients were managed with 1 PBD, 3/14 (21%) with 2 PBD, and 1/14 (7%) with 3 PBD. Nine of 14 (64%) patients were successfully managed with PBD and did not require re-operation. Three of 14 (21%) underwent re-transplantation, and two of 14 (14%) had surgical revision. There was one death during follow-up, and PBD management for one patient is ongoing. Thirteen of 14 donors had cholangiograms available for review. Ten of 13 (77%) demonstrated variant anatomy. The most common variant anatomy (7/10, 70%) was a right posterior duct inserting to a left duct (type A3), which comprises 17% of the general population. All patients requiring more than one PBD had donor liver variant biliary anatomy. This corresponded to 40% of patients with donor variant anatomy requiring multiple PBDs. Interventional radiology plays an important, and often salvage, role in the management of biliary complications after LDLT, commonly requiring 2 or more drains. Therefore, knowing the donor biliary anatomy is imperative to treating LDLT patients.