Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation

Shin Hwang, Sung Gyu Lee, Kyu Bo Sung, Kwang Min Park, Ki Hun Kim, Chul Soo Ahn, Young Joo Lee, Sung Koo Lee, Gyu Sam Hwang, Deok Bog Moon, Tae Yong Ha, Dong-Sik Kim, Jae Pil Jung, Gi Won Song

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

A considerable proportion of adult living donor liver transplantation (LDLT) recipients experience biliary complication (BC), but there are few reports regarding BC based on long-term studies of a large LDLT population. The present study examined BC incidence, risk factors and management using single-center data from 259 adult patients (225 right liver and 34 left liver grafts) between 2000 and 2002. The mean follow-up period was 46 ± 14 months. Biliary reconstruction included single duct-to-duct anastomosis (DD, n = 141), double DD (n = 19), single hepaticojejunostomy (HJ, n = 67), double HJ (n = 28), and combined DD and HJ (n = 4). There were 12 episodes of anastomotic bile leak and 42 episodes of anastomotic stenosis in 50 recipients. Most leaks occurred within the first month, whereas stenosis occurred over 3 yr. Most stenoses were successfully treated using radiological intervention. Cumulative 1-, 3-, and 5-yr BC rates were 12.9%, 18.2%, and 20.2%, respectively. BC occurred much more frequently in right liver grafts compared to left liver grafts (P = 0.024). Stenosis-free survival curves for right liver graft recipients were similar for all reconstruction groups. When right liver graft recipients with single biliary reconstructions were grouped according to graft duct size and type of biliary reconstruction, DD involving a small-sized duct (less than 4 mm in diameter) was found to be a BC risk factor (P = 0.015), whereas HJ involving such duct sizes was not found to be associated with a higher risk (P = 0.471). In conclusion, close surveillance for BC appears necessary for at least the first 3 yr after LDLT. We found that most BC could be successfully controlled using radiological intervention. In terms of anastomotic stenosis risk, HJ appears a better choice than DD for right liver grafts involving ducts less than 4 mm in diameter.

Original languageEnglish
Pages (from-to)831-838
Number of pages8
JournalLiver Transplantation
Volume12
Issue number5
DOIs
Publication statusPublished - 2006 May 1
Externally publishedYes

Fingerprint

Living Donors
Risk Management
Liver Transplantation
Transplants
Pathologic Constriction
Liver
Incidence
Anastomotic Leak
Patient Rights
Bile
Population

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Hwang, S., Lee, S. G., Sung, K. B., Park, K. M., Kim, K. H., Ahn, C. S., ... Song, G. W. (2006). Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation. Liver Transplantation, 12(5), 831-838. https://doi.org/10.1002/lt.20693

Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation. / Hwang, Shin; Lee, Sung Gyu; Sung, Kyu Bo; Park, Kwang Min; Kim, Ki Hun; Ahn, Chul Soo; Lee, Young Joo; Lee, Sung Koo; Hwang, Gyu Sam; Moon, Deok Bog; Ha, Tae Yong; Kim, Dong-Sik; Jung, Jae Pil; Song, Gi Won.

In: Liver Transplantation, Vol. 12, No. 5, 01.05.2006, p. 831-838.

Research output: Contribution to journalArticle

Hwang, S, Lee, SG, Sung, KB, Park, KM, Kim, KH, Ahn, CS, Lee, YJ, Lee, SK, Hwang, GS, Moon, DB, Ha, TY, Kim, D-S, Jung, JP & Song, GW 2006, 'Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation', Liver Transplantation, vol. 12, no. 5, pp. 831-838. https://doi.org/10.1002/lt.20693
Hwang, Shin ; Lee, Sung Gyu ; Sung, Kyu Bo ; Park, Kwang Min ; Kim, Ki Hun ; Ahn, Chul Soo ; Lee, Young Joo ; Lee, Sung Koo ; Hwang, Gyu Sam ; Moon, Deok Bog ; Ha, Tae Yong ; Kim, Dong-Sik ; Jung, Jae Pil ; Song, Gi Won. / Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation. In: Liver Transplantation. 2006 ; Vol. 12, No. 5. pp. 831-838.
@article{b9c3b694830d49d692a4745ab3874834,
title = "Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation",
abstract = "A considerable proportion of adult living donor liver transplantation (LDLT) recipients experience biliary complication (BC), but there are few reports regarding BC based on long-term studies of a large LDLT population. The present study examined BC incidence, risk factors and management using single-center data from 259 adult patients (225 right liver and 34 left liver grafts) between 2000 and 2002. The mean follow-up period was 46 ± 14 months. Biliary reconstruction included single duct-to-duct anastomosis (DD, n = 141), double DD (n = 19), single hepaticojejunostomy (HJ, n = 67), double HJ (n = 28), and combined DD and HJ (n = 4). There were 12 episodes of anastomotic bile leak and 42 episodes of anastomotic stenosis in 50 recipients. Most leaks occurred within the first month, whereas stenosis occurred over 3 yr. Most stenoses were successfully treated using radiological intervention. Cumulative 1-, 3-, and 5-yr BC rates were 12.9{\%}, 18.2{\%}, and 20.2{\%}, respectively. BC occurred much more frequently in right liver grafts compared to left liver grafts (P = 0.024). Stenosis-free survival curves for right liver graft recipients were similar for all reconstruction groups. When right liver graft recipients with single biliary reconstructions were grouped according to graft duct size and type of biliary reconstruction, DD involving a small-sized duct (less than 4 mm in diameter) was found to be a BC risk factor (P = 0.015), whereas HJ involving such duct sizes was not found to be associated with a higher risk (P = 0.471). In conclusion, close surveillance for BC appears necessary for at least the first 3 yr after LDLT. We found that most BC could be successfully controlled using radiological intervention. In terms of anastomotic stenosis risk, HJ appears a better choice than DD for right liver grafts involving ducts less than 4 mm in diameter.",
author = "Shin Hwang and Lee, {Sung Gyu} and Sung, {Kyu Bo} and Park, {Kwang Min} and Kim, {Ki Hun} and Ahn, {Chul Soo} and Lee, {Young Joo} and Lee, {Sung Koo} and Hwang, {Gyu Sam} and Moon, {Deok Bog} and Ha, {Tae Yong} and Dong-Sik Kim and Jung, {Jae Pil} and Song, {Gi Won}",
year = "2006",
month = "5",
day = "1",
doi = "10.1002/lt.20693",
language = "English",
volume = "12",
pages = "831--838",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "John Wiley and Sons Ltd",
number = "5",

}

TY - JOUR

T1 - Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation

AU - Hwang, Shin

AU - Lee, Sung Gyu

AU - Sung, Kyu Bo

AU - Park, Kwang Min

AU - Kim, Ki Hun

AU - Ahn, Chul Soo

AU - Lee, Young Joo

AU - Lee, Sung Koo

AU - Hwang, Gyu Sam

AU - Moon, Deok Bog

AU - Ha, Tae Yong

AU - Kim, Dong-Sik

AU - Jung, Jae Pil

AU - Song, Gi Won

PY - 2006/5/1

Y1 - 2006/5/1

N2 - A considerable proportion of adult living donor liver transplantation (LDLT) recipients experience biliary complication (BC), but there are few reports regarding BC based on long-term studies of a large LDLT population. The present study examined BC incidence, risk factors and management using single-center data from 259 adult patients (225 right liver and 34 left liver grafts) between 2000 and 2002. The mean follow-up period was 46 ± 14 months. Biliary reconstruction included single duct-to-duct anastomosis (DD, n = 141), double DD (n = 19), single hepaticojejunostomy (HJ, n = 67), double HJ (n = 28), and combined DD and HJ (n = 4). There were 12 episodes of anastomotic bile leak and 42 episodes of anastomotic stenosis in 50 recipients. Most leaks occurred within the first month, whereas stenosis occurred over 3 yr. Most stenoses were successfully treated using radiological intervention. Cumulative 1-, 3-, and 5-yr BC rates were 12.9%, 18.2%, and 20.2%, respectively. BC occurred much more frequently in right liver grafts compared to left liver grafts (P = 0.024). Stenosis-free survival curves for right liver graft recipients were similar for all reconstruction groups. When right liver graft recipients with single biliary reconstructions were grouped according to graft duct size and type of biliary reconstruction, DD involving a small-sized duct (less than 4 mm in diameter) was found to be a BC risk factor (P = 0.015), whereas HJ involving such duct sizes was not found to be associated with a higher risk (P = 0.471). In conclusion, close surveillance for BC appears necessary for at least the first 3 yr after LDLT. We found that most BC could be successfully controlled using radiological intervention. In terms of anastomotic stenosis risk, HJ appears a better choice than DD for right liver grafts involving ducts less than 4 mm in diameter.

AB - A considerable proportion of adult living donor liver transplantation (LDLT) recipients experience biliary complication (BC), but there are few reports regarding BC based on long-term studies of a large LDLT population. The present study examined BC incidence, risk factors and management using single-center data from 259 adult patients (225 right liver and 34 left liver grafts) between 2000 and 2002. The mean follow-up period was 46 ± 14 months. Biliary reconstruction included single duct-to-duct anastomosis (DD, n = 141), double DD (n = 19), single hepaticojejunostomy (HJ, n = 67), double HJ (n = 28), and combined DD and HJ (n = 4). There were 12 episodes of anastomotic bile leak and 42 episodes of anastomotic stenosis in 50 recipients. Most leaks occurred within the first month, whereas stenosis occurred over 3 yr. Most stenoses were successfully treated using radiological intervention. Cumulative 1-, 3-, and 5-yr BC rates were 12.9%, 18.2%, and 20.2%, respectively. BC occurred much more frequently in right liver grafts compared to left liver grafts (P = 0.024). Stenosis-free survival curves for right liver graft recipients were similar for all reconstruction groups. When right liver graft recipients with single biliary reconstructions were grouped according to graft duct size and type of biliary reconstruction, DD involving a small-sized duct (less than 4 mm in diameter) was found to be a BC risk factor (P = 0.015), whereas HJ involving such duct sizes was not found to be associated with a higher risk (P = 0.471). In conclusion, close surveillance for BC appears necessary for at least the first 3 yr after LDLT. We found that most BC could be successfully controlled using radiological intervention. In terms of anastomotic stenosis risk, HJ appears a better choice than DD for right liver grafts involving ducts less than 4 mm in diameter.

UR - http://www.scopus.com/inward/record.url?scp=33646443062&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646443062&partnerID=8YFLogxK

U2 - 10.1002/lt.20693

DO - 10.1002/lt.20693

M3 - Article

C2 - 16528711

AN - SCOPUS:33646443062

VL - 12

SP - 831

EP - 838

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 5

ER -