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Abstract

Objectives: Biliary complications are common after living-donor liver transplant. This retrospective study reviewed our experience with biliary complications in recipients of living-donor liver transplant. Materials and Methods: Over our 9-year study period, 120 patients underwent living-donor liver transplant. Patients were divided into 2 groups, with group A having biliary complications and group B without biliary complications. Both groups were compared, and different treatment modalities for biliary complications were evaluated. Results: Group A included 45 patients (37.5%), whereas group B included 75 patients (62.5%). Biliary complications included bile leak in 17 patients (14.2%), biliary stricture in 11 patients (9.2%), combined biliary stricture with bile leak in 15 patients (12.5%), and sphincter of Oddi dysfunction and cholangitis in 1 patient each (0.8%). Cold ischemia time was significantly longer in group A (P = .002). External biliary drainage was less frequently used in group A (P = .031). Technical success rates of endoscopic biliary drainage and percutaneous transhepatic biliary drainage were 68.3% and 41.7%. Survival rate following relaparotomy for biliary complications was 62.5%. Conclusions: Graft ischemia is an important risk factor for biliary complications. Bile leaks can predispose to anastomotic strictures. The use of external biliary drainage seems to reduce the incidence of biliary complications. Endoscopic and percutaneous transhepatic approaches can successfully treat more than twothirds of biliary complications. Relaparotomy can improve survival outcomes and is usually reserved for patients with intractable biliary complications.

Risk factors and management of biliary stones after living donor liver transplant and its effect on graft outcome

“…During the study period, 83 (out of 376 patients who underwent LDLT) patients developed biliary stricture, representing 22% of all recipients. This finding agrees with Sarhan et al ( 7 ) who reported an overall stricture rate of 21.7% in patients with LDLT. It is also consistent with Kim ( 17 ) in which biliary stricture occurred in 19.5% of recipients.…”

“…During the study period, 83 (out of 376 patients who underwent LDLT) patients developed biliary stricture, representing 22% of all recipients. This finding agrees with Sarhan et al (7) who reported an overall stricture rate of 21.7% Relatively, early detection of biliary stones may be related to multiple risk factors in the same patient and the successful follow-up program that allowed us to detect the problem early.…”

“…The development of bile stones after liver transplantation is attributed to many risk factors but the exact pathogenesis has not been clarified yet. The development of post-transplant biliary strictures, hepatic arterial thrombosis, ischemia-reperfusion injury, and prolonged cold ischemia times have been reported as possible risk factors for bile stones (5)(6)(7). Other studies suggested an association between cyclosporine, increased blood triglycerides and cholesterol levels, and the increased tendency for bile stone formation (8,9).…”