BACKGROUND: Biliary reconstruction in living donor liver transplantation is associated with an elevated rate of complications. The objective of the present study is to present our experience with biliary complications following living donor liver transplantation and their treatment. METHODS: Of a total of 300 hepatic transplantations, 51 (17%) were of living donors. All receptors had identical ABO blood group of the donors. Electronic charts of the receptors were evaluated to determine the presence and type of biliary tree anomalies, presence of vascular and biliary complications and technique and results of the treatment of the complications. RESULTS: The biliary duct was double in 7 grafts (16.7%) and triple in 2 (4.8%) grafts of the right lobe. In the remaining, the duct was single. The most common reconstitution procedure was single or double hepaticohepaticostomy (n = 38; 75%). Biliary complications occurred in 21 patients (41.2%) and included biliary fistula in 11 (21.6%), biliary stenosis in 6 (11.8%), and fistula with stenosis in 4 (7.8%). The fistula was at the biliary anastomosis in 11 patients (21.6%) and at the liver surface in 4 (7.8%). Treatment consisted of biliary stent insertion in 8, papillotomy in 1, retransplantation in 2 who had hepatic artery thrombosis, and suture of the biliary duct in 1. Fistula closed with conservative treatment in 3 patients. Most biliary stenosis was treated with dilation followed by biliary stent insertion. CONCLUSIONS: Biliary complications are frequent after living donor liver transplantation and they are associated with elevated rates of morbidity and mortality.
Biliary fistula; Liver transplantation; Postoperative complications
