Management of biliary complications following living donor liver transplantation—a single center experience

Abstract

Biliary complications (BC) after living donor liver transplantation (LDLT) are reported in up to 32%. We retrospectively reviewed the biliary reconstruction after 95 LDLT. Eighty-one right hemiliver grafts and 14 left lateral section grafts were transplanted. Bile duct anastomoses were performed as duct-to-duct (DD) or bilioenteric anastomosis (RYHJ); multiple bile ducts were anastomosed using a ductoplasty or multiple direct bile duct anastomoses. After right hemiliver LDLT, a total of 45.5% of BC was observed, with an incidence of 27.7% in case of DD anastomosis and 18.8% in case of RYHJ. After DD anastomosis, strictures were successfully treated endoscopically in 50%; insufficiencies mainly required reoperations. BC still account for a high percentage of morbidity and mortality after LDLT. DD anastomoses are performed more frequently and are feasible in cases with simple biliary anatomy; RYHJ is the gold standard for the reconstruction of multiple bile ducts.