Korean J Hepatobiliary Pancreat Surg.  2015 May;19(2):71-74. 10.14701/kjhbps.2015.19.2.71.

Long-term outcome of ischemic type biliary stricture after interventional treatment in liver living donors: a report of two cases

• Jung DH
• Hwang S
• Ha TY
• Song GW
• Kim KH
• Ahn CS
• Moon DB
• Park GC
• Jung BH
• Kwang SH
• Lee SG

• KMID: 2243052
• DOI: http://doi.org/10.14701/kjhbps.2015.19.2.71

Abstract

The wall of normal proximal bile duct is occasionally thin with close approximation to the right hepatic artery. Thus, isolation of this hepatic artery can result in excessive weakening of the remnant proximal bile duct wall during hemiliver graft harvest. This type of injury can induce ischemic stricture of the donor common bile duct. This study aimed to review the clinical sequences of such ischemic type donor bile duct injuries primarily managed with endoscopic and radiological interventional treatments. A retrospective review of medical records was performed for two living donors who suffered from ischemic type donor bile duct injury. They were followed up for more than 10 years. The right and left liver grafts were harvested from these two donors. Bile duct anatomy was normal bifurcation in one and anomalous branching in the other. Bile duct stenosis was detected in them at 2 weeks and 1 week after liver donation. They underwent endoscopic balloon dilatation and temporary stent (endoscopic retrograde biliary drainage tube) insertion. After keeping the tube for 2 months, the tube was successfully removed in one donor. However, endoscopic treatment was not successful, thus additional radiological intervention was necessary in the other donor. On follow-up over 10 years, they are doing well so far with no recurrence of biliary stricture. Based on our limited experience, interventional treatment with subsequent long-term follow-up appears to be an essential and choice treatment for ischemic type biliary stricture occurring in liver living donors.

Keyword

Living donor; Biliary complication; Biliary stricture; Endoscopic intervention; Ischemia

MeSH Terms

Bile Ducts
Common Bile Duct
Constriction, Pathologic*
Dilatation
Drainage
Follow-Up Studies
Hepatic Artery
Humans
Ischemia
Liver*
Living Donors*
Medical Records
Recurrence
Retrospective Studies
Stents
Tissue Donors
Transplants

Figure

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  Fig. 1 Clinical sequences in a donor following right liver hepatectomy with operative findings (A), at the time of diagnosis of biliary stricture after 2 weeks (B), at the time of resolution of biliary stricture after 2 months (C), and long-term follow-up findings after 10 years (D).

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  Fig. 2 Clinical sequences in a donor following left liver hepatectomy with operative findings (A), at the time of diagnosis of biliary stricture after 1 week (B), at the time of persistent biliary stricture after 4 months (C), and resolution of symptomatic biliary stricture after 10 months (D).

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