Risk Factors and Management for Biliary Complications Following Adult Living-Donor Liver Transplantation

Abstract

BackgroundBiliary complications (BCs) following liver transplantation are very serious. Nevertheless, it is still uncertain which components influence the incidence of BCs the most.Material/MethodsA consecutive sample of 74 adult recipients who underwent living-donor liver transplantation were enrolled in this study. BCs that were Clavien-Dindo classification grade II or higher were determined as BCs.ResultsThere were 11 out of the 74 recipients who experienced BCs. There were no differences in preoperative background factors between the BCs+ and BCs− group. Unexpectedly, the number of bile duct orifices did not contribute to the BCs (p=0.722). In comparison with the BCs− group, the frequency of post-operative bleeding requiring re-operation was relatively higher (27.3% vs. 7.9%, p=0.0913) and this complication was the only independent risk factor (p=0.0238) for the onset of BCs. Many of the BCs+ recipients were completely treated by endoscopic or radiological intervention (81.8%). However, surgical revision was required for 2 recipients (18.2%).ConclusionsGiven these results, it is reasonable to believe that definite hemostasis is required to prevent future BCs. In addition, bile duct multiplicity was not associated with BCs.

Expanding the donor pool: Donation after circulatory death and living liver donation do not compromise the results of liver transplantation

“…Overall, the biliary complication rate at our center is low compared with results reported in the Adult‐to‐Adult Living Donor Liver Transplantation Cohort Study (probability for leaks 26% and for strictures 32%) . Additionally, the rates are comparable to those of large Asian centers, where biliary complications have been described in a range between 15% and 35% …”

Impact on biliary complications of donor abdominal aortic calcification among living donor liver transplantation: a retrospective study

“…The previous studies showed several predictive factors for BC after LDLT, including postoperative bleeding requiring re‐operation [18], prolonged CIT [1], right liver grafts [19], a small‐sized duct (less than 4 mm in diameter) [2,20], cytomegalovirus infection [20], ductoplasty [19,20], HAT [19,20], and a graft presenting with multiple bile ducts [19,21]. In the present study, the results showed that the risk factors for BC were similar to the previous reports, except for donor AAC.…”

Myeloid-Derived Suppressor Cells as a Regulator of Immunity in Organ Transplantation

“…In clinical settings, an extensive immunosuppressive treatment is initiated from induction to around one month following transplantation, with systemic administration of several immunosuppressants even in stable cases [117,118]. Moreover, in acute rejection cases, high doses of steroid or anti-lymphocyte antibodies are usually required.…”