The rate of biliary adverse events in duct-to-duct living donor liver transplant compared with deceased donor liver transplant

Abstract

Background and AimsLiving donor liver transplantation (LDLT) allows for decreased listing-to-transplant time in patients with end-stage liver disease (ESLD) but has been noted to be associated with higher rates of biliary adverse events. We aim to assess the adverse events of LDLT and compare to deceased donor liver transplant (DDLT) patients. MethodsWe retrospectively reviewed patients having undergone duct-to-duct anastomosis LDLT at a single center from 2011-2020. Exclusion criteria included pediatric patients and LDLT with Roux-en-Y hepaticojejunostomy. Patients were then matched 1:1 with DDLT. Matching was performed by age, gender, etiology of liver disease, and MELD. Outcomes of interest included incidence of biliary strictures, bile leak, stricture recurrence rate and the number of interventions required for stricture resolution. ResultsFifty patients with LDLT were matched to 50 patients with DDLT. Bile leak occurred in 14 (38%) vs 5 (10%) patients in LDLT and DDLT groups, respectively (p-value 0.001). Biliary strictures occurred in 14(28%) vs 15(30%) patients in LDLT and DDLT groups, respectively (p-value 0.68). There was no difference in the median number of interventions required to resolve the strictures [3 (2-6) vs 4 (3-5), respectively; p-value 0.79]. Three patients in each group had recurrence of strictures after documented resolution. Mortality in both groups were similar [5 (10%) patients in LDLT vs 6(12%) in DDLT (P-value 0.75)]. ConclusionPatients who undergo LDLT were equally as likely to develop anastomotic strictures compared to DDLT. Duct-to-duct anastomosis LDLT should be frequently considered in patients with ESLD with favorable anatomy.