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Clin Transplant. 2010 Jul-Aug;24(4):535-42. doi: 10.1111/j.1399-0012.2009.01124.x.

Incidence and management of biliary complications after adult-to-adult living donor liver transplantation.

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Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.



There are few detailed reports of biliary complications in a large adult living donor liver transplantation (LDLT) series.


Biliary complications, treatment modalities, and outcomes in these patients were retrospectively analyzed in 310 adult LDLT.


One patient underwent retransplantation. Duct-to-duct anastomosis was primarily performed in 223 patients (72%). During the observation period (median 43 months), biliary complications were observed in 111 patients (36%); 53 patients (17%) had bile leakage, 70 patients (23%) had bile duct stenosis, and 12 patients (4%) had bile leakage followed by stenosis. A biliary anastomotic stent tube was placed in 266 patients (86%) at the time of transplantation. Univariate analysis of various clinical factors revealed duct-to-duct anastomosis as the single significant risk factor (p=0.009) for biliary complications. The three-yr and five-yr overall patient survival rates were 88% and 85% in those with biliary complications, and 85% and 83%, respectively, in those without biliary complications (p=0.59).


Biliary complications are a major cause of morbidity following LDLT. Duct-to-duct anastomosis carried a higher risk for bile duct stenosis. With appropriate management, however, there was little influence on overall survival.

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