Presented at the 9th Annual Meeting of the American Hepato-Pancreato-Biliary Association, 12–15 March 2009, Miami, FL, USA.
Biliary complications including single-donor mortality: experience of 207 adult-to-adult living donor liver transplantations with right liver grafts
Article first published online: 27 JAN 2010
© 2010 International Hepato-Pancreato-Biliary Association
Volume 12, Issue 2, pages 109–114, March 2010
How to Cite
El-Meteini, M., Hamza, A., Abdalaal, A., Fathy, M., Bahaa, M., Mukhtar, A., Abouelfetouh, F., Mostafa, I., Shaker, M., Abdelwahab, S., El-Dorry, A., El-Monayeri, M., Hobballah, A. and Sabry, H. (2010), Biliary complications including single-donor mortality: experience of 207 adult-to-adult living donor liver transplantations with right liver grafts. HPB, 12: 109–114. doi: 10.1111/j.1477-2574.2009.00142.x
- Issue published online: 8 FEB 2010
- Article first published online: 27 JAN 2010
- Received 17 September 2009; accepted 5 October 2009
- biliary complications;
- liver transplant
Background: After right lobe donation, biliary complication is the main cause of morbidity. Mortality after right lobe donation has been estimated to be less than 0.5%.
Patients and methods: Between November 2001 and December 2008, 207 adult-to-adult living donor liver transplantations (ALDLT) were undertaken using right lobe grafts. Donors included 173 men and 34 women with a mean age of 28.4 ± 5.2 years.
Results: Siblings comprised 144 (69.6%) cases whereas unrelated donors comprised 63 (30.4%) with a mean body mass index (BMI) of 25.2 ± 2.4. Single and multiple right hepatic ducts (RHD) were present in 82 (39.6%) and 125 (60.3%) donors, respectively. Mean operative time was 360 ± 50 min with an estimated blood loss of 950 ± 450 ml and returned cell-saver amount of 450 ± 334 ml. Mean donor remnant liver volume was 33.5 ± 3.2%. Mean intensive care unit (ICU) stay was 3 ± 0.7 days and mean hospital stay was 14 ± 3.5 days. Modified Clavien classifications were used to stratify all donor biliary complications The overall biliary complications occurred in 27 cases (13.0%). After modified Clavien classification, biliary complications were graded as grade I (n= 10), grade II (n= 2), grade III (n= 14) and grade V (n= 1). Grade I and II (n= 12) biliary complications were successfully managed conservatively. Grade III cases were treated using ultrasound-guided aspiration (USGA), endoscopic retrograde cholangiography (ERCP) and surgery in 10, 2 and 2 donors, respectively. Single donor mortality (Grade V) (0.4%) occurred after uncontrolled biliary leakage with peritonitis that necessitated exploration followed by ERCP with stent insertion but the donor died on day 43 as a result of ongoing sepsis.
Conclusion: Although the majority of biliary complications are minor and can be managed conservatively, uncontrolled biliary leakage is a serious morbidity that should be avoided as it could lead to mortality.