Biliary Complications Following Donation after Brainstem Death Liver Transplantation

Abstract

Introduction: Biliary complications are increasingly seen after liver transplantation. Different modalities are used to overcome these complications. In this study, we investigated the occurrence of biliary complications following donation after brainstem death (DBD) liver transplant and their management. Methods: A retrospective review of patients who underwent DBD orthotopic liver transplant (OLT) from October 2014 to October 2020. The primary outcome was biliary stricture and the secondary outcome was return to theatre. Results: A total of 366 patients underwent DBD whole OLT during the study period. There were 229 (62.6%) males and 137 (37.4%) females. Recipients median age was 55 years (range 16-73) and donors median age was 50.5 years (range 11-89). Mean cold ischaemic time was 581 ± 218.7 minutes. Duct to duct anastomosis was performed in 240 (65.6%) patients, and 126 (34.4%) patients underwent Roux-en-Y hepaticojejunostomy (RYHJ). Eighteen (4.9%) patients experienced bile leak, 39 (10.7%) patients experienced anastomotic biliary stricture (ABS) and 18 (4.9%) patients had ischaemic cholangiopathy. Hepatic artery thrombosis occurred in 27 (7.4%) patients, 29 (7.9%) patients had early allograft dysfunction and six (1.6%) patients experienced primary non function. ABS was treated with RYHJ in 23 (6.3%) patients, Endoscopic Retrograde Cholangiopancreatography (ERCP) in nine (2.5%) patients, conservative management in eight (2.2%) patients and retransplant in one (0.3%) patient. Overall, 84 (22.9%) patients returned to theatre and 27 (7.4%) patients underwent retransplant. Conclusion: Biliary complications following DBD liver transplant is a frequent occurrence and careful monitoring and planning is required to improve patients’ outcomes.