Diagnostic and Therapeutic Management Algorithm for Biliary
Complications in Living Liver Donors
Abstract
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.