Clinical

Biliary complications more common in living donors of right liver lobe grafts

Last Updated: 2008-07-04 9:00:22 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Living liver donors are significantly more likely to experience biliary complications when donating a right lobe than a left lobe, results of a study from Japan suggest. The researchers also found that endoscopic management of these complications is usually effective when conservative therapy fails.

"With the increasing number of living donor liver transplantations, biliary complications in donors have emerged as a major postoperative problem," the team points out in the June issue of the American Journal of Gastroenterology.

Dr. Seiji Shio and colleagues from the departments of gastroenterology, hepatology and surgery at Kyoto University Graduate School of Medicine analyzed biliary complications in 731 consecutive patients who donated liver grafts (434 right-lobe and 297 left-lobe grafts) for transplantation.

Overall, postoperative biliary complications occurred in 55 donors, or 7.5%. Initially, 48 of these 55 donors had biliary leakage and 7 had biliary stricture. Subsequently, 5 of the 48 donors with leakage developed biliary stricture.

According to the investigators, the rates of biliary leakage and overall biliary complications were significantly higher (p < 0.01) among right-lobe donors (9.9% and 11.1%, respectively) than among left-lobe donors (1.7% and 2.4%).

The incidence of biliary stricture was also higher among right-lobe donors than among left-lobe donors (2.1% vs 1.0%), but the difference did not reach statistical significance.

"Anatomic variations in the biliary tract appear to be one of the most important factors contributing to the higher incidence of biliary leakage among right-lobe donors," Dr. Shio and colleagues note.

Among the 55 donors with biliary complications, 24 were successfully treated with conservative therapy and 1 was converted to surgical repair due to ileus, the investigators report.

Eighty percent of the donors whose biliary complications could not be treated by conservative therapy were successfully treated with endoscopic retrograde cholangiography, while the remaining 20% underwent surgery due to difficulties with cannulation, excessive biliary leakage, or complete biliary obstruction.

Endoscopic treatment of biliary complications in living liver donors is effective, Dr. Shio and colleagues conclude, "and should be used as the first-line treatment for such complications."

Am J Gastroenterol 2008;103:1393-1398.