Free Paper Session : Biliary Diseases ; Risk Factors And Management Of Biliary Complications In Adult Living Donor Liver Transplantation Patients

다국어 초록 (Multilingual Abstract)

Background/Aims: The major morbidity after adult living donor liver transplantation (ALDLT) is due to biliary complications. The aim of the present study is to evaluate 1) the kinds of biliary complications and their incidence, 2) the risk factors of biliary stricture and 3) the clinical outcomes of management. Methods: Between January 2000 and December 2006, 259 adult patients underwent ALDLT at Seoul National University Hospital. Among 259 recipients, 20 patients died during the postoperative period. We retrospectively analyzed the remaining 239 patients. Results: The mean follow-up period was 40 months (range, 7-90 months), and the graft failure rate was 3%. The 1-year survival rate was 91%. The main causes of death were hepatocellular careinoma recurrence (65%), acute or chronic rejection (10%), sepsis (10%) and HCV reactivation (5%). The overall incidence of biliary complications was 28.9% for biliary stricture, 6.2% for bile leakage, 1.6% for bile duct stone and 0.8% for biliary cast. On multivariate analysis, the risk factors of biliary stricture were multiple bile duct anastomosis (OR 3.25, CI 1.2-8.7, p=0.02), bile leakage (OR 28.1, CI 3.3-238.1, p-0.02) and hepatic artery stenosis (OR 9.7, CI 2.3-41.4, p=0.002). All strictures were initially treated nonsurgically (endoscopic cholangioplasty, n=27; percutaneous cholangioplasty, n=41; and observation, n=1). However, 6 patients ultimately required biliary reconstruction. The patients with bile leakage were treated with endoscopic nasobiliary drainage (n=3), percutancous transbiliary drainage (n=11) or biliary reconstruction (n=1). Biliary casts and stones that developed after ALDLT were cured with endoscopic or percutaneous removal. Conclusions: The most common biliary complication after ALDLT was biliary stricture. Hepatic artery stenosis, multiple bile duct anastomosis and bile leakage were significantly associated with biliary stricture. Biliary complications can be successfully managed with nonsurgical methods.