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Diagnostic and Therapeutic Management Algorithm for Biliary Complications in Living Liver Donors
  • +11
  • Sezai Yilmaz,
  • Sami Akbulut,
  • Sertac Usta,
  • Oguzhan Ozsay,
  • Tevfik Tolga Sahin,
  • Kemal Baris Sarici,
  • Adil Baskiran,
  • Fatih Gonultas,
  • Fatih Ozdemir,
  • Veysel Ersan,
  • Burak Isik,
  • Ramazan Kutlu,
  • Abuzer Dirican,
  • Murat Harputluoglu
Sezai Yilmaz
Inonu University

Corresponding Author:[email protected]

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Sami Akbulut
Inonu University
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Sertac Usta
Inonu University
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Oguzhan Ozsay
Inonu University
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Tevfik Tolga Sahin
Inonu University
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Kemal Baris Sarici
Inonu University
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Adil Baskiran
Inonu University
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Fatih Gonultas
Inonu University
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Fatih Ozdemir
Inonu University
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Veysel Ersan
Inonu University
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Burak Isik
Inonu University
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Ramazan Kutlu
Inonu University Faculty Of Medicine
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Abuzer Dirican
Inonu University
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Murat Harputluoglu
Inonu University Faculty Of Medicine
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Abstract

Background: Complications in living liver donors are one of the main concerns about living donor liver transplantation and the most important of all are biliary complications. Objective: To present the diagnostic and therapeutic algorithm developed for the postoperative biliary complications in living liver donors (LLDs). Methods: Between September 2005 and October 2019, 2120 living liver donor candidates underwent living donor hepatectomy and postoperative biliary complications developed in 167 (7.87%). Management algorithm for various biliary complications and living liver donors who required hepaticojejunostomy were evaluated for this retrospective cohort study. Results: Fifty-one LLDs underwent 53 relaparotomy procedures due to biliary peritonitis. Endoscopic retrograde cholangiopancreatography (sphincterotomy┬▒ stenting) was performed in 104 donors but due to persistent bile duct stricture ┬▒ bile leaks, percutaneous transhepatic biliary tract drainage catheter was inserted in six donors following a failed endoscopic retrograde cholangiopancreatography assisted treatment. Ninety-seven LLDs underwent interventional radiologic procedure and twelve of them were percutaneous transhepatic biliary tract drainage. HJ was performed in 10 LLDs with right lobe LDH and 2 LLDs with left lobe LDH. Ten of the 12 LLDs underwent percutaneous transhepatic biliary tract drainage catheter assisted HJ in a median of 50 days after LDH. Following HJ, 11 LLDs did not have any complication along the median of 978 days (min-max: 139-3578) of follow-up. Conclusion: As living donor liver transplantation will continue to be performed in countries with low cadaveric organ supply and biliary complications will be encountered following LDH. Timing of management of the biliary complication is vital and HJ procedure is the ultimate treatment modality for biliary complications that cannot be solved by other minimally invasive methods especially percutaneous transhepatic biliary tract drainage.
Nov 2021Published in Transplant International volume 34 issue 11 on pages 2226-2237. 10.1111/tri.14104