Biliary complications and their management in living donor liver transplantation (LDLT) are not well characterized, despite the opposite being the case in adult cadaveric liver transplantation (CLT).
Janak N. Shah and colleagues have now assessed the role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and management of biliary complications following LDLT.
They performed a retrospective cohort analysis of all LDLT recipients with duct-to-duct anastomoses (n = 15).
Specific data they collected included referral for ERCP, diagnosis, and therapy.
Comparisons were then made to a cohort of 260 CLT recipients.
The research showed that a greater percentage of LDLT recipients underwent ERCP (73%) than did CLT recipients (25%).
As diagnosed by ERCP, biliary complications were also more frequent in LDLT recipients than in CLT recipients.
Such complications consisted of leaks and strictures and were diagnosed in 53% and 12%, and 27% and 5% of LDLT and CLT patients respectively.
The majority of leaks occurred at T-tube sites (LDLT: 87%; CLT: 65%).
Diagnosis and therapy of leaks required a median of 2 ERCP procedures in both groups.
However, bile leaks were successfully treated endoscopically in 100% and 84% of LDLT and CLT recipients, respectively.
In the case of strictures, diagnosis and treatment occurred with a median of 1.5 procedures for LDLT recipients and 2 procedures for CLT recipients.
|Biliary complications were more common in LDLT recipients than CLT recipients|
|American Journal of Gastroenterology|
The duration of endoscopic therapy was a median of 10 and 14 wk, and success rates were 75% and 62% in LDLT and CLT groups, respectively.
Commenting on their findings, the researchers said that their study showed that LDLT is associated with increased biliary complications as compared to CLT.
They added that, "ERCP is useful for diagnosis, can successfully treat most LDLT-related biliary complications, and should be attempted prior to more invasive interventions."