Biliary Strictures in 130 LDLT Recipients

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Biliary

Strictures in 130 Consecutive Right Lobe Living Donor Liver Transplant

Recipients: Results of a Western Center

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. šSource:

American Journal

of Transplantation, Volume 7, Number 1, January 2007,

pp. 161-167(7)š Publisher: Blackwell

Publishing

Abstract:

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.