Abstract
Biliary complications are reported in 11-40% of adult right lobe living donor liver transplants (ARLLDLT), incidence being higher with multiple graft ducts. We reviewed the technique and outcomes of biliary reconstruction in ARLLDLT’s with ≥2 graft ducts. The aim of this study was to evaluate the success of endoscopic and percutaneous treatment in such patients with biliary complications. ABO incompatible, re-transplants, and primary sclerosing cholangitis recipients were excluded. Multiple ducts were present in 810 (53%) amongst 1536 ARLLDLTs from 2011-17. Single anastomosis (2D-1A or3D-1A) was performed in 436(54%), of which 405 had 2 graft ducts, and 31 had ≥3. Recipient common bile duct (r-CBD) was used in 413(95%) and roux -en Y hepaticojejunostomy (RYHJ) in 23(5%). Multiple anastomoses (≥2) were performed in 374 (46.2%). The type of anastomoses were: 2 graft ducts, 2 anastomoses(2D-2A); 285(76%); 3D-2A;70(19%), 3D-3A;15(4%), and 4D-2A;4(1%). For multiple anastomoses, recipient right hepatic duct (r-RHD) and recipient left hepatic duct (r-LHD) were used in 283, r-CBD and r-cystic duct in 64, r-CBD +RYHJ in 10, and only RYHJ in 17. At a median follow up of 36 months, biliary complication rate was 16.9%, higher than overall series (13.5%; p=0.03). Of 28 leaks (3.45%), 20 were re-explored, 9 converted to RYHJ. Of 109 strictures (13.45%), 87% were managed by endoscopic retrograde cholangiography and stenting (ERCP), 13 with ERCP+ percutaneous transhepatic biliary drainage (PTBD) using rendezvous technique. At last follow up, 93% were stent free, with remodelled strictures. The 5-yr OS in this group with multiple ducts was similar to overall cohort (90.4% vs.89%, p=0.293). Biliary strictures are the most commonly seen biliary complication after ARLLDLT. However, endoscopic and percutaneous treatment is successful in the majority of these patients and the overall outcome is comparable.
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