Effect of Biliary Tract Variations on Biliary Complications in Living Donor Liver Transplantation

Abstract

Dividing bile ducts during donor hepatectomy is one of the critical step of the living donor liver transplantation. To determine the biliary anatomy of graft who underwent right lobe donor hepatectomy in our center and to evaluate effect of biliary variations on recipient biliary complications was the main purpose of this study. The data of donors who were performed right donor hepatectomy between January 2016 and January 2018, were analyzed retrospectively. Two hundred twenty-nine patients who were carried out right lobe donor hepatectomy and the recipients of these donors who had at least two years follow-up were included in the study. Recipients who underwent liver transplantation due to primary biliary pathology and re-transplanted recipients were excluded. The most detected biliary type was A1 (45%) according to Huang classification. Donors were divided into three groups in related to number of bile duct orifice as group A, B and C which contains one, two and three bile duct orifices, respectively and postoperative biliary complications were compared between these groups. There were 123 (53,7%), 94 (41%) and 12 (5,2%) patients in Group A, B and C, respectively. Thirty-six recipients (15,7%) experienced biliary complications. There was no statistical difference between groups associated with biliary complications (p>0.05). The number of greft bile orifice has no effect on recipient biliary complications wether, if the pre-perioperative assessment of bile anatomy is investigated effectively and the surgical strategy is decided properly.

Keywords

• Liver transplantation
• Bile duct anatomy
• Living donor
• Biliary complications

Canlı Donör Karaciğer Naklinde Safra Yolu Varyasyonlarının Biliyer Komplikasyonlara Etkisi

Abstract

Canlı donör karaciğer nakillerinde, donör safra yollarının bölünmesi donör hepatektominin en kritik aşamalardan biridir. Bu çalışmada, merkezimizde sağ lobektomi uygulanan canlı donörlerin safra yolu varyasyonlarının belirlenmesi ve bu varyasyonların postoperatif alıcı safra komplikasyonları ile ilişkisi araştırılmıştır. Ocak 2016 ile Ocak 2018 arasında yapılan canlı donör hepatektomi olgularının verileri retrospektif olarak incelendi. Araştırmaya sağ lobektomi uygulanan donörler (229 olgu) ve minimum 2 yıl takip süresi olan alıcıları dahil edildi. Re-trasnplantasyon yapılan ve primer biliyer patoloji nedeniyle karaciğer nakli uygulanan alıcılar çalışma dışı bırakıldı. Huang sınıflamasına göre en sık tespit edilen tip A1 (%45) idi. Donörler, greft safra ağzı tek, çift ve üç adet olanlar şeklinde sırasıyla grup A,B ve C olmak üzere üç gruba ayrılarak postoperatif komplikasyonlar karşılaştırıldı. Group A, B ve C sırasıyla 123 (%53,7) , 94 (%41) ve 12 (%5,2) olgudan oluştu. 36 hastada safra komplikasyonu (darlık, kaçak) tespit edildi (%15,7). Gruplar arasında yapılan karşılaştırmada safra komplikasyonu açısından anlamlı fark tespit edilmedi (p>0.05). Pre-perioperatif safra yolu değerlendirmesinin etkin yapılması ve uygun cerrahi stratejinin belirlenmesi durumunda greft safra ağzı sayısının alıcı safra komplikasyonları açısından kötü prognostik etkisi yoktur.

Keywords

• Karaciğer nakli
• Safra yolu anatomisi
• Canlı donör
• Safra komplikasyonu

References

1. Gondolesi GE, Varotti G, Florman, et al. Biliary Complications in 96 Consecutive Right Lobe Living Donor Transplant Recipients. Transplantation. 2004;77(12):1842-8.
2. Takatsuki M, Eguchi S, Kawashita Y, Kanematsu T. Biliary complications in recipients of living-donor liver transplantation. J Hepatobiliary Pancreat Surg. 2006;13:497–501.
3. Yazumi S, Chiba T. Biliary complications after a right-lobe living donor liver transplantation. J Gastroenterol. 2005;40:861–5.
4. Yaprak O, Dayangac M, Akyildiz M, et al. Biliary complica-tions after right lobe living donor liver transplantation: a single-centre experience. HPB (Oxford). 2012;14(1):49-53.
5. Ye S, Dong JH, Duan WD, Ji WB, Liang YR. The Preliminary Study on Procurement Biliary Convergence from Donors with Complicated Bile Duct Variant in Emergency Right Lobe Living Donor Liver Transplantation. J Clin Exp Hepatol. 2017;7:33–41.
6. Huang TL, Cheng YF, Chen CL, Chen TY, Lee TY. Variants of the bile ducts: clinical application in the potential donor of living-related hepatic transplantation. Transpl Proc. 1996;128:1669–70.
7. Nakamura T, Tanaka K, Kiuchi T, et al. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases. Transplantation. 2002;73:1896–1903.
8. Varotti G, Gondolesi GE, Goldman J, et al. Anatomic variations in right liver living donors. J Am Coll Surg. 2004; 198:577–82.

9. Chaib E, Kanas AF, Galvão FHF, D'Albuquerque LAC. Bile duct confluence: anatomic variations and its classification. Surg Radiol Anat. 2014;36(2):105-9.
10. Karakas HM, Celik T, Alicioglu B. Bile duct anatomy of the Anatolian Caucasian population: Huang classification revisited. Surg Radiol Anat. 2008;30:539–45.
11. Uysal F, Obuz F, Uçar A, Seçil M, Igci E, Dicle O. Anatomic variations of the intrahepatic bile ducts: analysis of magnetic resonance cholangiopancreatography in 1011 consecutive patients. Digestion. 2014;89(3):194-200.
12. Chittapuram S, Ramesh Babu, Malay Sharma. Biliary tract anatomy and its relationship with venous drainage. J Clin Exp Hepatol. 2014;4 (Suppl 1):18-26.
13. Dusunceli E, Erden A, Erden I. Anatomic variations of the bile ducts: MRCP findings. Tani Girisim Radyol. 2004;10:296–303
14. Chok KSH, Lo CM. Systematic review and meta-analysis of studies of biliary reconstruction in adult living donor liver transplantation. ANZ J Surg. 2017;78:121–5.
15. Azzam AZ, Tanaka K. Biliary complications after living donor liver transplantation: A retrospective analysis of the Kyoto experience 1999–2004. Indian J Gastroenterol. 2017;36(4):296–304.
16. Mathew JS, Manikandan K, Kumar KYS, et al. Biliary complications among live donors following live donor liver transplan-tation. The Surgeon. 2018;16:214-9.
17. Tezcaner T, Dinç N, Karakayalı FY et al. Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant. Exp Clin Transplant. 2019;17(6):759-67.
18. Nakamura T, Iida T, Ushigome H, et al. Risk Factors and Management for Biliary Complications Following Adult Living-Donor Liver Transplantation. Ann Transplant. 2017; 22:671-6.