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.

Aim: To analyze developing infections after living donor hepatectomy (LDH) in living liver donors (LLDs). Methods: Demographic and clinical charecteristics of 1106 LLDs were retrospectively analysed in terms of whether postoperative infection development. Therefore, LLDs were divided into two group: with (n=190) and without (n=916) antimicrobial agent use. Results: The median age was 29.5 (min-max: 18-55). A total of 257 (23.2%) infection attacks (min-max: 1-8) was developed in 190 (17.2%) LLDs. The patients with infection that were longer intensive care unit (ICU) and hospital stays, higher hospital admissions, emergency transplantation, invasive procedures for ERCP, PTC biloma and abscess drainage, and the presences of relaparatomies and transcystic catheters. Infection attacks derived from a 58.3% hepatobiliary system, 13.2% urinary system, 6.6% surgical site and 5.8% respiratory system. The most common onset symptoms were fever, abdominal pain, nausea and vomiting. A total of 125 positive results was detected from 77 patients with culture positivity. The most detected microorganisms from the cultures taken are Extended-Spectrum β-lactamases (ESBL) producing Klebsiella pneumonia (16.8%) and Escherichia coli (16%), Methicillin-Resistant Staphylococcus aureus [(MRSA) (9.6%)], Methicillin-susceptible Staphylococcus aureus [(MSSA (9.6%)] and Pseudomonas aeruginosae (8.8%), respectively. The average number of ICU hospitalization days was 3±2 (min 1-max 30, IQR:1) and hospitalization days was 14±12 (min 3-max 138, IQR: 8). All infection attacks were successfully treated. No patients died due to infection or another surgical complication. Conclusion: Infections commonly observed infected biloma, cholangitis and abscess arising from the biliary system and other nosocomial infections are the feared complications in LLDs. These infections should be managed multidisciplinary without delay and carefully.