Initial Outcome of External Biliary Drainage Tube Insertion in Living Donor Liver Transplantation: Pure Laparoscopic Donor Hepatectomy Dominant Center Experience

Abstract

Introduction: Surgical technique advancements and enhanced perioperative management improved outcome in living donor liver transplantation (LDLT) recipients. However, biliary complication(BC) including biliary leakage(BL) and biliary stricture(BS) continues to be the most common and intractable complication due to surgical/non-surgical factors. This study compared the incidence of biliary complication (BC) in adult living donor liver transplant recipients who underwent right-lobe duct-to-duct anastomosis (DDA) with or without external biliary drainage (EBD). Methods: This study compares the incidence of biliary complication after LDLT between EBD group (n = 40) and non-EBD group (n = 150) retrospectively. Total 190 patients who received LDLT with duct-to-duct anastomosis in SNUH from July 2017 to October 2020 were included in the analysis. Donor operation was pure laparoscopic surgery. Biliary complication included all short-term and long-term biliary leakage or biliary stricture of Clavien-Dindo grade III or higher. Results: The incidence of overall biliary complication(BC) was 16/40(40.0%) in EBD group and 76/150(50.7%) in non-EBD group (p = 0.230). The incidence of biliary leakage(BL) was 2.5% in EBD group and 14.6% in non-EBD group (p = 0.036). The EBD related complication(Clavien-Dindo grade III or higher) rate was 5.0%. Conclusion: This study shows that EBD insertion is effective in decreasing the rate of biliary leakage in LDLT recipients with duct-to-duct anastomosis. While the overall EBD related complication rate was high, most were minor complications such as self-removal or EBD retraction. Further research is needed to determine the optimal time of EBD clamping and removal.