The Long-Term Prognosis and Treatments of Biliary Complications After Living Donor Liver Transplantation.

Abstract

Purpose: Biliary complications after living donor liver transplantation (LDLT) are classified as hepaticojejunostomy anastomotic strictures (HJS) and non-anastomotic biliary strictures (NAS). We present a retrospective analysis of the long-term prognosis and treatsments of biliary complications in hepaticojejunostomy. Methods: Between May 2001 and May 2011, 199 LDLTs were performed using S2 monosegment, lateral segment or left lobe grafts. The median age and body weight at LDLT were 1.6 years (0.1-19.5 years) and 9.8 kg (2.6-65.0 kg), respectively. The median observation period was 6.8 years (2.7-12.7 years) after LDLT. Results: The overall incidence of HJS was 18.1% (36/199). Multivariate analysis revealed that left lobe grafts were an independent risk factor for HJS (p=0.034). There were 2 surgical reconstructions, 18 percutaneous biliary drainages (PTBD), 14 double balloon enteroscopies (DBE) and 2 rendezvous penetration procedures were performed for recipients with HJS. The incidence of recurrent HJS was 36.1% (13/36). The graft survival of recipients with and without HJS was 97.2% and 91.4% (p=0.532), respectively, and the graft failures were not due to complications associated with HJS. The overall incidence of NAS was 2.5% (5/199). The causes of NAS were hepatic arterial thrombosis in 1 recipient, intrahepatic bile duct injury associated with ABO-incompatible LDLT in 1 recipient, intrahepatic bile duct injury associated with acute cellular rejection in 2 recipients and unknown etiology in 1 recipient. PTBD were performed for all recipients with NAS, but 1 recipient underwent re-transplantation eight months after the first LDLT due to graft failure secondary to refractory cholangitis. Four recipients were able to undergo PTBD tube removal, but 2 recipients suffered from liver dysfunction. Conclusions: Although HJS occurs even in a late period after LDLT, the long-term prognosis is good because graft failure can be avoided by early diagnosis and treatment. However, NAS can develop into graft failure and suffers from a poor long-term prognosis.