Diagnostic and therapeutic management algorithm for biliary complications in living liver donors.

YILMAZ S., AKBULUT A. S., Usta S., Ozsay O., ŞAHİN T. T., SARICI K. B., ...More

Transplant international : official journal of the European Society for Organ Transplantation, vol.34, no.11, pp.2226-2237, 2021 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 34 Issue: 11
  • Publication Date: 2021
  • Doi Number: 10.1111/tri.14104
  • Journal Name: Transplant international : official journal of the European Society for Organ Transplantation
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.2226-2237
  • Keywords: biliary complications, hepaticojejunostomy, living donor hepatectomy, living donor liver transplantation, percutaneous transhepatic biliary tract drainage, SINGLE-CENTER, TRANSPLANTATION, HEPATECTOMY, EXPERIENCE
  • Inonu University Affiliated: Yes

Abstract

This study aimed to demonstrate the efficacy of our diagnostic and therapeutic management algorithm and catheter-assisted (percutaneous transhepatic biliary tract drainage [PTBD] or transanastomotic feeding tube) hepaticojejunostomy (HJ) procedures in living liver donors (LLDs) with biliary complications. Living donor hepatectomy (LDH) was performed between September 2005 and April 2021 in 2 489 LLDs. Biliary complications developed in 220 LLDs (8.8%), 136 of which were male, and the median age was 29 (interquartile range [IQR]: 12) years. Endoscopic sphincterotomy +/- stenting was performed in 132 LLDs, which was unsuccessful in 9 LLDs and required HJ. Overall, 142 LLDs underwent interventional radiologic procedures. Fifteen LLDs with biliary complications underwent HJ (PTBD catheter = 6 and transanastomotic feeding tube = 9) at a median of 44 days (IQR: 82). Following HJ, 14 LLDs did not have any complications throughout the median follow-up period of 1619 days (IQR: 1454). However, percutaneous dilation for HJ anastomotic stricture was performed in one patient. Biliary complications are very common following LDH; therefore, surgeons in the field should have a low threshold to perform HJ for biliary complications that persist after other treatments. Our catheter-assisted HJ techniques demonstrated a high success rate and aided HJ in a hostile abdomen during revisional surgery.