J Korean Soc Transplant.  2005 Dec;19(2):198-204.

Management of Biliary Problem in Dual Living Donor Liver Transplantation

• Jung JP
• Lee SG
• Hwang S
• Kim KH
• Ahn CS
• Moon DB
• Ha TY
• Song KW
• Kim DS
• Moon KM
• Kim BS
• Jung DH
• Lee YJ
• Park KM

Abstract

PURPOSE
For the safety of donor and recipient in living donor liver transplantation, Asan Medical Center had attempted dual living donor liver transplantation (DLDLT) for the first time in the world. But bleeding chance and biliary problem occurred twofold in DLDLT, because DLDLT was used dual grafts. We analyzed the clinical features, the diagnosis, and management of biliary problem in DLDLT.
METHODS
We retrospectively analyzed the cases of 61 patients had undergone DLDLT between July 2003 and June 2004. The cases with biliary problem was diagnosed by serologic examination (glutamic oxaloacetic transaminase/ glutamic pyruvic transaminase/alkaline phosphatase/total bilirubin) and image study (computed tomography and hepatobiliary scan).
RESULTS
Among 61 cases had undergone DLDLT, 19 cases had biliary problem included biliary stricture only (14 cases), biliary stricture and bile leakage (5 cases). The major clinical manifestations of biliary problem were fever (12 cases), asymptomatic and/or increased liver enzyme (7 cases). Among 19 cases with biliary problem, 18 cases showed image study positive and serologic examination positive and/or symptomatic findings, and 1 cases showed image study positive and serologic examination negative and asymptomatic findings. The treatments of biliary stricture were endoscopic (naso/retrograde) biliary drainage (4 cases), percutaneous transhepatic biliary drainage (17 cases). In cases of bile leakage, we treated intraabdominal fluid collection with operative management (1 cases) and conservative managements (4 cases). Mortality rate related with biliary problem was 0%.
CONCLUSION
Systemic and active postoperative management in biliary complication can help patients to minimize economic loss and sequelae.

Keyword

Dual living donor liver transplantation; Biliary stricture; Bile leakage; Endoscopic (naso/retrograde) biliary drainage; Percutaneous transhepatic biliary drainage

MeSH Terms

Bile
Chungcheongnam-do
Constriction, Pathologic
Diagnosis
Drainage
Fever
Hemorrhage
Humans
Liver Transplantation*
Liver*
Living Donors*
Mortality
Retrospective Studies
Tissue Donors
Transplants