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World Journal of Surgery

, Volume 31, Issue 11, pp 2222–2229 | Cite as

Biliary Complications after Duct-to-duct Biliary Reconstruction in Living-donor Liver Transplantation: Causes and Treatment

  • Hirotaka TashiroEmail author
  • Toshiyuki Itamoto
  • Tamito Sasaki
  • Hideki Ohdan
  • Yasuhiro Fudaba
  • Hironobu Amano
  • Saburo Fukuda
  • Hideki Nakahara
  • Kohei Ishiyama
  • Akihiko Ohshita
  • Toshihiko Kohashi
  • Hiroshi Mitsuta
  • Kazuaki Chayama
  • Toshimasa Asahara
Article

Abstract

Background

In living-donor liver transplantation (LDLT), biliary complications are recognized as a significant cause of post-transplantation morbidity.

Methods

Eighty patients who underwent LDLT with duct-to-duct biliary reconstruction at Hiroshima University Hospital were enrolled in this study. The mean follow-up was 24 months (range, 3–72 months). Eighteen patients underwent the basiliximab-based immunosuppressive therapy, and 62 patients underwent non-basiliximab-based immunosuppressive therapy. The development of biliary complications after LDLT was retrospectively analyzed. Biliary complications were initially treated by endoscopic or radiological modalities.

Results

Biliary leakages and strictures occurred in 12 (15%) and 20 (25%) of the 80 patients, respectively. Stepwise multivariate analysis demonstrated bile leakage to be an independent risk factor for the development of biliary stricture (p = 0.001) and basiliximab-based immunosuppressive therapy to be an independent protective factor for postoperative biliary leakage (p = 0.005). The 1-week total doses of steroids were significantly lower in the basiliximab-based immunosuppressive regimes (mean dose: 573mg) than in the non-basiliximab-based ones (mean dose: 1,121mg) (p = 0.01). All patients with biliary leakage were successfully treated with endoscopic or radiological modalities, except one patient who was treated by surgical treatment. Endoscopic or radiological modalities were successful as primary treatment modalities in 12 (60%) of 20 patients with biliary strictures. Lastly, six patients were treated surgically with long-term success, except for one patient with chronic cholangitis who died after 16 months.

Conclusions

Steroid-sparing basiliximab-based immunosuppressive therapy reduced the incidence of biliary leakage, and biliary leakage was the independent factor for biliary stricture. The non-surgical and surgical treatments for biliary complications were satisfactory.

Keywords

Bile Duct Hepatic Duct Biliary Stricture Biliary Complication Basiliximab 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This work was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan, and a grant-in-aid for research from the Tuchiya Foundation.

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Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Hirotaka Tashiro
    • 1
    Email author
  • Toshiyuki Itamoto
    • 1
  • Tamito Sasaki
    • 2
  • Hideki Ohdan
    • 1
  • Yasuhiro Fudaba
    • 1
  • Hironobu Amano
    • 1
  • Saburo Fukuda
    • 1
  • Hideki Nakahara
    • 1
  • Kohei Ishiyama
    • 1
  • Akihiko Ohshita
    • 1
  • Toshihiko Kohashi
    • 1
  • Hiroshi Mitsuta
    • 1
  • Kazuaki Chayama
    • 2
  • Toshimasa Asahara
    • 1
  1. 1.Second Department of SurgeryHiroshima UniversityHiroshimaJapan
  2. 2.First Department of Internal MedicineHiroshima UniversityHiroshimaJapan

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