Biliary complications in living donor liver transplantation

Cronin, David; Alonso, Emilio Ridruejo; Piper, James; Newell, K A; Bruce, David S.; Woodle, E. Steve; Whitington, P F; Thistlethwaite, J. Richard; Millis, J. Michael

doi:10.1016/s0041-1345(96)00160-1

Cited by 48 publications

(36 citation statements)

References 3 publications

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“…6,11,106 The data for RL transplants are still limited, but the initial incidence in our series was similar. 16 Several factors unique to partial grafts contribute to the greater incidence of biliary complications.…”

Section: Biliary Complicationsmentioning

confidence: 51%

Right lobe living donor liver transplantation: A review

Marcos

2000

Liver Transpl

158

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The continuing shortage of organs for adult transplant recipients has generated enthusiasm for adult-to-adult living donor liver transplantation (LDLT). The major concern has been the ability to resect a graft of adequate size without subjecting the donor to undue risk. The right hepatic lobe is generally large enough for adult recipients, but because of the real and perceived risks of right lobe (RL) resection, surgeons have been hesitant to offer this option to their patients. The first series of RL resections that included a significant number of patients was reported in 1999, and the results were encouraging. Only minor complications occurred in donors, and the recipients fared quite well. Enthusiasm for these donor resections is growing, and more centers are beginning to perform them. There is a good deal of global experience with pediatric LDLT but little with adults, and there are unique considerations in this population. This review examines donor selection criteria for adult recipients, highlights technical points critical for good outcome, and examines the early results and complications in both donors and recipients. If the preliminary results continue to be reproduced, RL LDLT could have significant impact on the worsening organ shortage.

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Section: Biliary Complicationsmentioning

confidence: 51%

Right lobe living donor liver transplantation: A review

Marcos

2000

Liver Transpl

158

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“…9,10 In pediatric living related liver transplantation with the use of the left lateral lobe of the liver, including segments 2 and 3, the reported incidence of biliary complications is approximately 4% to 6%, 2 with a significant decrease after the early experience in which the incidence was approximately 15% to 20%. 2,11,12 A direct comparison with the 2 previously mentioned procedures is only partially possible because of the difference in the way the anastomosis is performed. In full-liver cadaveric transplantation, the anastomosis is performed on the intact hepatic duct so that only 1 anastomosis, in presumably well-vascularized tissue, must be performed.…”

Section: Discussionmentioning

confidence: 99%

Biliary anastomosis in living related liver transplantation using the right liver lobe: Techniques and complications

et al. 2000

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Since the introduction of adult-to-adult living donor liver transplantation using the right lobe of the liver, biliary problems have led the list of complications resulting in postoperative morbidity. We report our experience with the first 30 living donor liver transplantations performed in our institution from August 1998 to January 2000. Patients were 21 men and 9 women, with a mean age 45 ؎ 16 years. Mean recipient weight was 65.1 ؎ 17.9 kg, mean graft weight was 877 ؎ 146 g, and the mean graft-recipient weight ratio was 1.5 ؎ 0.6. Patient and graft survival rates were 83.3% and 80%, respectively. Biliary anastomosis was either an end-to-end hepaticocholedochostomy with a T-drain or hepaticojejunostomy. Mean follow-up was 217.4 ؎ 149.8 days. The overall complication rate was 26.6% (8 of 30 procedures) and was directly correlated to the type of anastomosis and number of bile ducts. Surgical revision was necessary in all cases. Biliary complications were not the primary cause of graft loss. Adult living donor liver transplantation using the right lobe is a successful procedure, with graft and patient survival similar to those in cadaver full-organ transplantation. Postoperative morbidity, mainly caused by biliary leak, was directly related to the number of ducts and type of anastomosis. With increasing experience, we have better defined our plane of transection on the hilar plate, with the goal of obtaining only 1 biliary duct for the anastomosis. We also improved our parenchymal transection technique, which resulted in a decreased incidence of leak at the cut-surface area. (Liver Transpl 2000;6:710-714.)

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“…This parallels the initial results of LDLT in the pediatric population. 12,13 Leakage from the cut surface of the liver, usually manifested by biloma formation, was the most common finding, but stricture and anastomotic leak were also observed. Surgical management was almost universally required.…”

Section: Analysis Of 40 Right-lobe Liver Transplantsmentioning

confidence: 99%

Single-center analysis of the first 40 adult-to-adult living donor liver transplants using the right lobe

et al. 2000

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The first adult-to-adult living donor liver transplant using the right hepatic lobe in the United States was performed only 2 years ago. Although initial reports were encouraging, continuous review of the results and appropriate modifications in patient management will be necessary to minimize donor risk and optimize recipient outcome. The results of 40 such transplantations were analyzed and are summarized. Recipients were listed for transplantation according to the usual criteria. Living donors were not considered for United Network for Organ Sharing status IIA patients after the initial 22 patients. Donor evaluation followed a rigid protocol. A graft-to-recipient body weight ratio of at least 0.8% was the minimum required throughout most of the study. The surgical procedures were similar, except the plane of transection was modified to better accommodate donor biliary anatomy, and uniform stenting of bile ducts was practiced after the first 10 transplants. Immunosuppression consisted of tacrolimus, mycophenolate mofetil, and a prednisone taper. The target tacrolimus level was decreased and mycophenolate was withdrawn more rapidly in the second half of the study because of the absence of acute cellular rejection. Donor morbidity has been limited to minor complications, and transplant recipient biliary complications decreased from 35% to 0%. Acute cellular rejection has not been observed despite less aggressive immunosuppression, and septic complications decreased dramatically. There have been no recipient deaths since these changes were instituted. Right lobectomy can be performed safely in the donor population. Recipient biliary complications can be minimized with stenting. Less aggressive immunosuppression is well tolerated and minimizes septic complications and attributable mortality. (Liver Transpl 2000;6:296-301.) L iver transplantation has evolved in response to the continued and worsening shortage of organs. Surgical techniques to safely resect viable grafts from living donors have been developed and have the potential to significantly reduce mortality for patients with acute and chronic liver disease. The pediatric population has already realized the benefit of living donors, but progress has been slower for adults. Right lobectomy is the only segmental resection that consistently yields a graft of appropriate size for adults, but it has been approached cautiously because of concern for the safety of the donor. It has only been within the last 2 years that centers in the United States have started to offer this option to their patients. The early reports were encouraging, and enthusiasm has grown as a result. The continued use of this technique must, however, be dependent on a very low incidence of donor complications and demonstrated efficacy in recipients.The results of the first 25 adult-to-adult living donor liver transplantations (LDLTs) using the right lobe (RL) performed at our institution were analyzed and previously reported. 1 Only minor complications occurred in donors, and recipient morbidi...

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Biliary complications in living donor liver transplantation

Cited by 48 publications

References 3 publications

Right lobe living donor liver transplantation: A review

Right lobe living donor liver transplantation: A review

Biliary anastomosis in living related liver transplantation using the right liver lobe: Techniques and complications

Single-center analysis of the first 40 adult-to-adult living donor liver transplants using the right lobe

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