AUTHOR=Kim Min Seob , Hong Suk Kyun , Woo Hye Young , Cho Jae-Hyung , Lee Jeong-Moo , Yoon Kyung Chul , Choi YoungRok , Yi Nam-Joon , Lee Kwang-Woong , Suh Kyung-Suk
TITLE=Optimal Intervention for Initial Treatment of Anastomotic Biliary Complications After Right Lobe Living Donor Liver Transplantation
JOURNAL=Transplant International
VOLUME=35
YEAR=2022
URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10044
DOI=10.3389/ti.2022.10044
ISSN=1432-2277
ABSTRACT=Background: This study evaluated endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) as interventions for patients with anastomotic biliary complications (ABC) after living donor liver transplantation (LDLT).
Methods: Prospectively collected data of patients who were diagnosed with ABC after LDLT between January 2013 and June 2017 were retrospectively reviewed.
Results: There were 57 patients who underwent LDLT with a right liver graft using duct-to-duct biliary reconstruction and experienced ABC. Among the patients with RAD involvement, there were no significant differences in the intervention success (p = 0.271) and patency rates (p = 0.267) between ERCP and PTBD. Similarly, among the patients with RPD involvement, there were no significant differences in the intervention success (p = 0.148) and patency rates (p = 0.754) between the two procedures. Graft bile duct variation (p = 0.013) and a large angle between the recipient and graft bile duct (R-G angle) (p = 0.012) significantly increased the likelihood of failure of ERCP in the RAD. When the R-G angle was greater than 47.5°, the likelihood of ERCP failure increased.
Conclusion: We recommend PTBD when graft bile duct variation is presented in patients with RAD involvement and/or when the R-G angle is greater than 47.5°.