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COMPARATIVE STUDY OF BILLIARY COMPLICATIONS AFTER LIVING DONOR LIVER TRANSPLANTATION

Introduction: A considerable proportion of adult living donor liver transplantation (LDLT) recipients are biliary complication (BC). But there are few reports regarding BC based on long-term studies. The present study examined between 2011 and 2017 year’s First Central Hospital’s 40 cases’ BC incidence, risk factors, management and compared with Asan Medical Center 2000 and 2002 years 259 adult patients (225 right liver and 34 left liver grafts) cases. Materials and Methods: The mean follow-up period was 72±1 months. Biliary reconstruction included single duct-to-duct anastomosis (DD, n=31), double DD (n=2), single hepatojejunostomy (HJ, n=4), double HJ (n=1), and combined DD and HJ (n=1) in our center, which compared with other center. There were 4 episodes of anastomotic bile leaks and 5 episodes of anastomotic stenosis in our center. Most leaks occurred within the first month, whereas stenosis occurred over 2 yr. Results: Most stenosis were successfully treated using radiological intervention. Cumulative 1-, 3-, and 5-yr BC rates were 14,8%, 18.2%, and 20.2%, respectively. Our 1 cases had biliary leak on post operation 2 months. BC occurred much more frequently in right liver grafts compared to left liver grafts (P=0.024). Stenosis-free survival curves for right liver graft recipients were similar for all reconstruction groups. When right liver graft recipients with single biliary reconstructions were grouped according to graft duct size and type of biliary reconstruction, DD involving a small-sized duct (less than 4 mm in diameter) was found to be a BC risk factor (P=0.015), whereas HJ involving such duct sizes was not found to be associated with a higher risk (P=0.471). Conclusion: Close surveillance for BC appears necessary for at least the first 3 yr after LDLT. We found that most BC could be successfully controlled using radiological intervention. In terms of anastomotic stenosis risk, HJ appears a better choice than DD for right liver grafts involving ducts less than 4 mm in diameter.