Biliary Complications after Living Donor Liver Transplantation Differ from Those after Deceased Donor Liver Transplantation

Abstract

Yoon et al. 1 analyzed 3,481 Korean patients who underwent liver transplantation (LT) between 2012 and 2014, followed by endoscopic and radiological biliary interventions. This paper was meaningful as it was a national survey using Korea Health Insurance Review and Assessment data. 2 However, the codes reflected only the procedures performed; the reasons, methods, and results were lacking. Also, it was unclear whether surgery featured duct-to-duct anastomosis or hepaticojejunostomy in patients undergoing living donor LT (LDLT).LT in Korea differs markedly from that in Western countries. The LDLT rate is more than 2-fold higher than that of deceased donor LT (DDLT). 3 Lee et al. 3 established right-lobe LDLT in Korea. Accordingly, in recent years, Korea has become a leading country in LDLT. In Korea's family-centered culture, this surgery has become a source of hope for end-stage liver-disease patients. However, compared to DDLT, LDLT is more difficult and is associated with a higher incidence of biliary complications. 4 Duct-toduct anastomosis is preferred to hepaticojejunostomy in LDLT for various reasons. When duct-to-duct anastomosis is performed, the bile duct anastomosis site is higher (at the hilum) than in DDLT. In LDLT, the angle between the bile duct of the new liver and the extrahepatic bile duct is acute, which is associated with risks of ischemia and traction in surrounding tissues. If the transplanted liver becomes hypertrophic, an anastomotic stricture is possible. 5-8 Also, anastomotic stricture sometimes accompanies bile leakage.Yoon et al. 1 reported that the average number of biliary interventions in LDLT patients was 3.4±2.0, of which the