ABSCTRACT
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.
Key Words; Living donor liver transplantation; Living Donor
Hepatectomy; Biliary Complications; Percutaneous transhepatic biliary
tract drainage; Hepaticojejunostomy