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Publication Type : Journal Article
Thematic Areas : Medical Sciences
Publisher : Surgeon
Source : Surgeon, Volume 16, Issue 4, p.214-219 (2018)
Keywords : adult, Anastomotic Leak, Bile, Biliary Fistula, Biliary Tract Diseases, female, Hepatectomy, Humans, liver, liver transplantation, Living Donors, male, middle aged, Risk Factors, Tissue and Organ Harvesting
Campus : Kochi
School : School of Medicine
Department : Gastrointestinal Surgery
Year : 2018
Abstract : INTRODUCTION: In live donor liver transplantation (LDLT), bile duct division is a critical step in donor hepatectomy. Biliary complications hence are a feared sequelae even among donors. Long term data on biliary complications in donors from India are sparse.METHODS: Prospective evaluation of 452 live donors over 10 years was performed to ascertain the incidence & risk factors of clinically significant biliary complications.
RESULTS: Of the 452 donor hepatectomies (M: F = 114:338, median age = 38), 66.2% (299) were extended right lobe grafts, 24.1% (109) modified right lobe and 9.7% (44) were left lobe grafts. Portal vein anatomy was Type-I in 85% (386), Type-II in 7.5% (34) and Type-III in 7.1% (32). Following donor hepatectomy, a single bile duct opening occurred only in 46.5% (210) of the grafts. Of the remaining 53.5% grafts, 2 ductal openings were noted in 217 (48%) and three ductal openings in 25 (5.5%). Incidence of multiple openings in the duct were more commonly noted in Type II (70.6%) and III (75%) portal vein anatomy than in grafts with Type I (50.4%) portal anatomy (P = 0.001) Bile leak was noted in 15 (3.3%) donors which included one broncho-biliary fistula and bilio-pleural fistula. Analysis revealed no association between post-operative biliary complications and type of graft, portal vein anatomy or biliary anatomy. There was a single mortality in this series secondary to biliary sepsis. On long term follow, there were no biliary strictures in any of the patients.CONCLUSIONS: Biliary complications although rare (3.3%), present significant peri-operative morbidity to the donors.
Cite this Research Publication : J. Shaji Mathew, Manikandan, K., Kumar, K. Y. Santosh, Binoj, S. T., Dinesh Balakrishnan, Gopalakrishnan, U., Menon, R. Narayana, Dhar, P., Sudheer, O. V., Aneesh, S., and Sudhindran, S., “Biliary complications among live donors following live donor liver transplantation.”, Surgeon, vol. 16, no. 4, pp. 214-219, 2018.