Biliary complications following donor hepatectomy in live donor liver transplantation (LDLT)

Abstract

Introduction: Donor biliary complications are among the most feared in LDLT. Nevertheless, data regarding the incidence and risk factors for biliary complications is sparse. Aims and methods: Prospective evaluation of 348 live donors over 8 years to ascertain the incidence and risk factors of clinically significant biliary complications. Results: Of 348 donor hepatectomies (Males-94, Females-254, Median age-38years), 72%(251) were Extended Right-Lobe Grafts, 17.5%(61) Modified Right-Lobe and 10.5%(36) Left-Lobe Grafts. Portal Vein anatomy was Type-I in 83%(290), Type-II in 8.6%(30) and Type-III in 8%(28). Following duct division, number of openings on the donor bile ducts were, one in 197 (56%), two in 136 (39%) and three in 15 (4.3%). Incidence of multiple ducts in Type-I Portal Vein anatomy was 51%, in Type-II 73% and 71% in Type-III. Type II/III Portal Vein anatomy was associated with variant biliary anatomy (p = 0.003). Bile leak occurred in 6 patients (1.7%), manifesting as bilioma (4), broncho-biliary fistula (1) and bilio-pleural fistula (1). Percutaneous drainage followed by Endoscopic Stenting was successful in controlling bile leak in these donors. Another 38 patients had collection on Ultrasound which settled spontaneously. The patient with broncho-biliary fistula required laparotomy for source control followed by Endoscopic stenting. Over a median follow up of 33 months, none of the donors developed biliary strictures. Three donors died due to unrelated causes more than a year after surgery. Analysis revealed no association between type of graft, donor portal or biliary anatomy and biliary complications in the donor. Conclusions: Biliary complications although rare (1.7%) following donor hepatectomy, present significant short term morbidity to the donors.