Cannulation of the non visualised duct: Managing biliary complications after adult-to-adult living donor liver transplantation

Abstract

Background: Anatomic variations of donor bile ducts may be a significant cause of post-transplant morbidity. The aim of this study is to evaluate the impact of donor biliary variations on recipients' outcome in (AALDLT). Methods: From 2008 to 2015, 420 patients underwent AALDLT with duct-to-duct biliary reconstruction. According to donor biliary anatomy, right liver grafts (RLG) were classified into 2 groups; grafts with single right bile duct (RBD) (group1, n = 254) and grafts with multiple RBDs (group 2, n = 166). duct-to-duct biliary reconstruction was done. Type I: single right bile duct to recipient's common hepatic duct (CHD); Type II: 2 right sectorial bile ducts anastomosed to the recipient's right & left hepatic ducts; Type III: ductoplasty of the graft's sectorial bile ducts anastomosed to the recipient's CHD. mean follow-up 12 months. Results: Multiple RBDs included 2 or 3 RBD in (46.7%) and (3.3%) cases, respectively. type I in 50% of cases, type II in 21.6% and type III in 28.3%. In type 1, the incidence of biliary leakage, cholangitis & stricture was 3.3%, 13.3% & 20% respectively. In group 2 recipients, the incidence of biliary leakage, cholangitis & stricture was 8.7%, 10% & 26.7% respectively. There were no statistical significant differences in early or late biliary complications. Endoscopic management was the primary treatment modality in all patients with biliary strictures and leakage. Conclusion: Biliary complications could be managed endoscopically. RLGs with multiple biliary orifices should not be prohibited as it does not penalize recipient biliary reconstruction outcome in AALDLT.