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Bile leak following living donor liver transplantation: Clinical efficacy of percutaneous transhepatic treatment
Author(s) -
Kim Jin Hyoung,
Ko GiYoung,
Sung KyuBo,
Yoon HyunKi,
Gwon Dong Il,
Kim Kyung Rae,
Lee SungGyu
Publication year - 2008
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21501
Subject(s) - medicine , percutaneous , surgery , balloon dilation , jaundice , liver transplantation , leak , anastomosis , catheter , endoscopic treatment , balloon catheter , endoscopy , transplantation , balloon , environmental engineering , engineering
Abstract Percutaneous transhepatic treatment may be effective in patients with bile leaks after living donor liver transplantation (LDLT). We therefore evaluated the clinical efficacy of percutaneous transhepatic treatment for biliary leaks in adult‐to‐adult LDLT recipients. Twenty‐three LDLT recipients underwent percutaneous transhepatic treatment to manage bile leaks. The treatment included percutaneous transhepatic biliary drainage (PTBD) and drainage of perihepatic biloma. In patients with combined biliary strictures, balloon dilation was usually performed. Indications for PTBD included patients who had a Roux‐en‐Y hepaticojejunostomy (n = 9), failed endoscopic cannulation of bile ducts (n = 6), a bile leak refractory to endoscopic management (n = 5), and a poor general condition for endoscopic management (n = 3). Clinical success was achieved in 16 of 23 (70%) patients. PTBD catheters were removed from 14 of the 16 patients with clinical success at a median of 8 months (range, 3‐42 months) after initial PTBD. Aside from 1 patient with intrahepatic pseudoaneurysms, there were no major complications. During a median follow‐up period of 42 months (range, 3.0‐84 months), 6 (43%) of the 14 patients who underwent PTBD catheter removal experienced jaundice or cholangitis due to biliary anastomotic stricture at a median of 26 months (range, 22‐49 months) after PTBD catheter removal. In conclusion, percutaneous transhepatic treatment for biliary leaks in adult‐to‐adult LDLT recipients is clinically effective. This approach is a valuable alternative for treating bile leaks resistant to or inaccessible by endoscopic methods. However, further investigations are needed to minimize the duration of treatment and biliary strictures following PTBD catheter removal. Liver Transpl 14:1142–1149, 2008. © 2008 AASLD.