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Adult living donor liver transplants: biliary morbidity
Author(s) -
Giacomoni A.,
Lauteri A.,
Slim A.,
Mangoni I.,
Aseni P.,
Pirotta V.,
Mariani A.,
De Carlis L.
Publication year - 2006
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2006.00577_3_8.x
Subject(s) - medicine , anastomosis , cholangiography , biliary tract , liver transplantation , bile duct , surgery , bile duct diseases , magnetic resonance imaging , biliary ducts , biliary tract surgical procedures , radiology , transplantation
Biliary problems are very common complications in adult living donor liver transplants (ALDLTs), with a reported negative incidence of 22% to 64%. Patients and methods: From March 2001 through February 2006, we performed 27 ALDLTs, grafting segments V‐VIII without the middle hepatic vein. Biliary anatomy was investigated using intraoperative cholangiography in the first 5 patients and with magnetic resonance cholangiography alone in the remaining 22. In 15 patients, we found a single right biliary duct (55.55%) and in 12 we found multiple biliary ducts (44.45%). We performed single biliary anastomoses in 20 patients (74.07%) and multiple anastomoses in the remaining 7 (25.93%). Results: With a mean follow‐up of 675 days (range, 8 to 1,804 days), patient and graft survival rates were 85% and 74%. The following biliary complications were observed: 4 biliary leaks from the cut surface, 3 anastomotic leaks, 6 late anastomotic strictures, and 1 early kinking of the choledochus. These 14 biliary complications (51.85%) occurred in 11 patients (40.74%). Conclusion: Biliary complications affected our series of ALDLTs at a high percentage, but none of the grafts transplanted was lost due to biliary problems. Magnetic resonance cholangiography seems to be a reliable instrument to investigate biliary anatomy. Multiple biliary reconstructions are strongly associated with a high risk of complications.