1. Biliary complications among live donors following live donor liver transplantation
- Author
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Surendran Sudhindran, Ramachandran Narayana Menon, Johns Shaji Mathew, S.T. Binoj, O. V. Sudheer, S.A. Aneesh, K. Manikandan, K.Y. Santosh Kumar, Puneet Dhar, Dinesh Balakrishnan, and Unnikrishnan Gopalakrishnan
- Subjects
Adult ,Male ,medicine.medical_specialty ,Biliary Fistula ,Live donor ,Fistula ,medicine.medical_treatment ,Biliary Tract Diseases ,Anastomotic Leak ,030230 surgery ,Liver transplantation ,Gastroenterology ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Living Donors ,Medicine ,Bile ,Hepatectomy ,Humans ,business.industry ,Bile duct ,Middle Aged ,medicine.disease ,Lobe ,Surgery ,Liver Transplantation ,medicine.anatomical_structure ,Liver ,Long term data ,Tissue and Organ Harvesting ,030211 gastroenterology & hepatology ,Female ,business ,Duct (anatomy) - Abstract
Introduction In live donor liver transplantation (LDLT), bile duct division is a critical step in donor hepatectomy. Biliary complications hence are a feared sequelae even among donors. Long term data on biliary complications in donors from India are sparse. Methods Prospective evaluation of 452 live donors over 10 years was performed to ascertain the incidence & risk factors of clinically significant biliary complications. Results Of the 452 donor hepatectomies (M: F = 114:338, median age = 38), 66.2% (299) were extended right lobe grafts, 24.1% (109) modified right lobe and 9.7% (44) were left lobe grafts. Portal vein anatomy was Type-I in 85% (386), Type-II in 7.5% (34) and Type-III in 7.1% (32). Following donor hepatectomy, a single bile duct opening occurred only in 46.5% (210) of the grafts. Of the remaining 53.5% grafts, 2 ductal openings were noted in 217 (48%) and three ductal openings in 25 (5.5%). Incidence of multiple openings in the duct were more commonly noted in Type II (70.6%) and III (75%) portal vein anatomy than in grafts with Type I (50.4%) portal anatomy ( P = 0.001) Bile leak was noted in 15 (3.3%) donors which included one broncho-biliary fistula and bilio-pleural fistula. Analysis revealed no association between post-operative biliary complications and type of graft, portal vein anatomy or biliary anatomy. There was a single mortality in this series secondary to biliary sepsis. On long term follow, there were no biliary strictures in any of the patients. Conclusions Biliary complications although rare (3.3%), present significant peri-operative morbidity to the donors.
- Published
- 2017