Biliary complications including single-donor mortality: experience of 207 adult-to-adult living donor liver transplantations with right liver grafts

• Published in: HPB (Oxford, England) Vol. 12; no. 2; pp. 109 - 114
• Main Authors: El-Meteini, Mahmoud, Hamza, Alaa, Abdalaal, Amr, Fathy, Mohamed, Bahaa, Mohamed, Mukhtar, Ahmed, Abouelfetouh, Fawzia, Mostafa, Ibrahim, Shaker, Mohamed, Abdelwahab, Sameh, El-Dorry, Ahmed, El-Monayeri, Magda, Hobballah, Ali, Sabry, Hasan
• Format: Journal Article
• Language: English
• Published: Oxford, UK Elsevier Ltd 01-03-2010; Blackwell Publishing Ltd
• Subjects: Adolescent; Adult; biliary complications; Biliary Tract Diseases - etiology; Biliary Tract Diseases - mortality; Biliary Tract Diseases - therapy; Blood Loss, Surgical; Blood Transfusion, Autologous; Cholangiopancreatography, Endoscopic Retrograde; Critical Care; donors; Egypt; Female; Hepatectomy - adverse effects; Hepatectomy - mortality; Humans; Length of Stay; liver transplant; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Living Donors; Male; Middle Aged; Original; Reoperation; Severity of Illness Index; Siblings; Suction; Time Factors; Ultrasonography, Interventional; Young Adult; Egypt; donors; liver transplant; biliary complications
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1111/j.1477-2574.2009.00142.x

After right lobe donation, biliary complication is the main cause of morbidity. Mortality after right lobe donation has been estimated to be less than 0.5%.
Between November 2001 and December 2008, 207 adult-to-adult living donor liver transplantations (ALDLT) were undertaken using right lobe grafts. Donors included 173 men and 34 women with a mean age of 28.4 ± 5.2 years.
Siblings comprised 144 (69.6%) cases whereas unrelated donors comprised 63 (30.4%) with a mean body mass index (BMI) of 25.2 ± 2.4. Single and multiple right hepatic ducts (RHD) were present in 82 (39.6%) and 125 (60.3%) donors, respectively. Mean operative time was 360 ± 50min with an estimated blood loss of 950 ± 450ml and returned cell-saver amount of 450 ± 334ml. Mean donor remnant liver volume was 33.5 ± 3.2%. Mean intensive care unit (ICU) stay was 3 ± 0.7 days and mean hospital stay was 14 ± 3.5 days. Modified Clavien classifications were used to stratify all donor biliary complications The overall biliary complications occurred in 27 cases (13.0%). After modified Clavien classification, biliary complications were graded as grade I (n= 10), grade II (n= 2), grade III (n= 14) and grade V (n= 1). Grade I and II (n= 12) biliary complications were successfully managed conservatively. Grade III cases were treated using ultrasound-guided aspiration (USGA), endoscopic retrograde cholangiography (ERCP) and surgery in 10, 2 and 2 donors, respectively. Single donor mortality (Grade V) (0.4%) occurred after uncontrolled biliary leakage with peritonitis that necessitated exploration followed by ERCP with stent insertion but the donor died on day 43 as a result of ongoing sepsis.
Although the majority of biliary complications are minor and can be managed conservatively, uncontrolled biliary leakage is a serious morbidity that should be avoided as it could lead to mortality.