Biliary Strictures in 130 Consecutive Right Lobe Living Donor Liver Transplant Recipients: Results of a Western Center

• Published in: American journal of transplantation Vol. 7; no. 1; pp. 161 - 167
• Main Authors: Shah, S. A., Grant, D. R., McGilvray, I. D., Greig, P. D., Selzner, M., Lilly, L. B., Girgrah, N., Levy, G. A., Cattral, M. S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2007; Blackwell
• Subjects: Adult; Age Factors; Aged; Anastomosis, Surgical; Bile duct; Bile Ducts - abnormalities; Bile Ducts - surgery; Biliary Tract Diseases - surgery; Biliary Tract Surgical Procedures; Biological and medical sciences; Female; Follow-Up Studies; Graft Survival; Humans; leak; Length of Stay; liver; Liver Transplantation - adverse effects; Liver Transplantation - methods; living donor; Living Donors; Male; Medical sciences; Middle Aged; Prospective Studies; Risk Factors; stricture; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; transplantation; Biliary tract; Center; Digestive system; Living donor; Liver; Leak; Stenosis; Transplantation; Homotransplantation; Bile duct; Result; Treatment; Surgery; Graft; Hepatic lobe; stricture
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2006.01601.x

Biliary strictures remain the most challenging aspect of adult right lobe living donor liver transplantation (RLDLT). Between 04/2000 and 10/2005, 130 consecutive RLDLTs were performed in our center and followed prospectively. Median follow‐up was 23 months (range 3–67) and 1‐year graft and patient survival was 85% and 87%, respectively. Overall incidence of biliary leaks (n = 19) or strictures (n = 22) was 32% (41/128) in 33 patients (26%). A duct‐to‐duct (D‐D) or Roux‐en‐Y (R‐Y) anastomosis were performed equally (n = 64 each) with no difference in stricture rate (p = 0.31). The use of ductoplasty increased the number of grafts with a single duct for anastomosis and reduced the biliary complication rate compared to grafts ≥2 ducts (17% vs. 46%; p = 0.02). Independent risk factors for strictures included older donor age and previous history of a bile leak. All strictures were managed nonsurgically initially but four patients ultimately required conversion from D‐D to R‐Y. Ninety‐six percent (123/128) of patients are currently free of any biliary complications. D‐D anastomosis is safe after RLDLT and provides access for future endoscopic therapy in cases of leak or stricture. When presented with multiple bile ducts, ductoplasty should be considered to reduce the potential chance of stricture. The pattern and management of biliary strictures after right‐lobe living donor liver transplantation (RLDLT) from this experience from a single Western center shows that, although biliary strictures are common in RLDLT, they can usually be managed non‐operatively and do not affect short‐term graft survival.