Impact of early biliary complications on long-term outcomes in adult-to-adult living donor liver transplant recipients

BACKGROUND: An adult-to-adult living donor liver transplant (LDLT) has emerged as a possible option to help alleviate the organ shortage. The aim of this study was to analyze our experience with biliary complications in LDLT recipients and to identify their risk factors for biliary complications. This paper aimed to describe therapeutic interventions and to evaluate the impact of biliary complications on long-term patient and graft survival rates. METHODS: We evaluated biliary complications in a cohort of 120 LDLT recipients at a single institution and studied the impact on long-term graft and patient survival. RESULTS: Of the 120 recipients, 26 (21.7%) developed biliary complications. Endoscopy was the initial choice of treatment for recipients with biliary complications. The median time for resolution of bile leaks was 37 days; for resolution of strictures, 82 days. A decreased risk of biliary complications was associated with an interrupted duct-to-duct (versus continuous choledocho-choledochostomy) (hazard ratio [HR]=0.22, P=0.002) and a Roux-en-Y hepaticojejunostomy (HR=0.13, P<0.001). In multivariate analysis of factors associated with graft failure and patient mortality, biliary complications were unrelated to long term (3 and 5 years) graft failure or patient mortality. CONCLUSIONS: In our study LDLT recipients had a 21.7% incidence of biliary complications, however, with successful endoscopic techniques, long-term patient and graft survival rates were not negatively affected.