Surgery Today

, Volume 40, Issue 5, pp 411–417 | Cite as

Biliary complications in living liver donors

  • Yufeng Yuan
  • Mitsukazu Gotoh
Review Article


With the increasing use of living donor liver transplantation (LDLT), the morbidity and mortality of the donors have thus become inevitable problems associated with this procedure. The most common postoperative complications among donors for LDLT involve the biliary tract. The incidence of biliary complications in donors tends to be about 5% based on recent publications. Anatomical variations in the biliary tract, higher predonation alkaline phosphatase levels, and intraoperative blood transfusions are also risk factors for biliary complications in the donors after donation. Donors with biliary complications often show unspecific symptoms and most of the biliary complications can be normally treated by nonsurgical methods. Interventional procedures such as percutaneous placement of a peritoneal drain, percutaneous/endoscopic biliary drainage, and combinations of balloon dilatation and/or stenting are effective in the treatment of bile leakage and biliary stricture. A clear understanding of the biliary anatomy of each donor and refined surgical techniques will help to minimize risk of biliary complications for living liver donors.

Key words

Living liver donor Biliary complications 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Liu CL, Fan ST, Lo CM, Wei WI, Chan SC, Yong BH, et al. Operative outcomes of adult-to-adult right lobe live donor liver transplantation: a comparative study with cadaveric whole-graft liver transplantation in a single center. Ann Surg 2006;243:404–410.CrossRefPubMedGoogle Scholar
  2. 2.
    Freeman RB Jr, Steffick DE, Guidinger MK, Farmer DG, Berg CL, Merion RM. Liver and intestine transplantation in the United States, 1997–2006. Am J Transplant 2008;8:958–976.CrossRefPubMedGoogle Scholar
  3. 3.
    Florman S, Miller CM. Live donor liver transplantation. Liver Transpl 2006;12:499–510.CrossRefPubMedGoogle Scholar
  4. 4.
    Nadalin S, Malagò M, Radtke A, Erim Y, Saner F, Valentin-Gamazo C, et al. Current trends in live liver donation. Transpl Int 2007;20:312–330.CrossRefPubMedGoogle Scholar
  5. 5.
    Trotter JF, Adam R, Lo CM, Kenison J. Documented deaths of hepatic lobe donors for living donor liver transplantation. Liver Transpl 2006;12:1485–1488.CrossRefPubMedGoogle Scholar
  6. 6.
    Bramstedt KA. Living liver donor mortality: where do we stand? Am J Gastroenterol 2006;101:755.CrossRefPubMedGoogle Scholar
  7. 7.
    Barr ML, Belghiti J, Villamil FG, Pomfret EA, Sutherland DS, Gruessner RW, et al. A report of the Vancouver Forum on the care of the live organ donor: lung, liver, pancreas, and intestine data and medical guidelines. Transplantation 2006;81:1373–1385.CrossRefPubMedGoogle Scholar
  8. 8.
    Chan SC, Fan ST. Historical perspective of living donor liver transplantation. World J Gastroenterol 2008;14:15–21.CrossRefPubMedGoogle Scholar
  9. 9.
    Ghobrial RM, Freise CE, Trotter JF, Tong L, Ojo AO, Fair JH, et al.; A2ALL Study Group. Donor morbidity after living donation for liver transplantation. Gastroenterology 2008;135:468–476.CrossRefPubMedGoogle Scholar
  10. 10.
    Yi NJ, Suh KS, Cho JY, Lee HW, Cho EH, Yang SH, et al. Three-quarters of right liver donors experienced postoperative complications. Liver Transpl 2007;13:797–806.CrossRefPubMedGoogle Scholar
  11. 11.
    Brown RS Jr, Russo MW, Lai M, Shiffman ML, Richardson MC, Everhart JE, et al. A survey of liver transplantation from living adult donors in the United States. N Engl J Med 2003;348:818–825.CrossRefPubMedGoogle Scholar
  12. 12.
    Tamura S, Sugawara Y, Kaneko J, Yamashiki N, Kishi Y, Matsui Y, et al. Systematic grading of surgical complications in live liver donors according to Clavien’s system. Transpl Int 2006;19:982–987.CrossRefPubMedGoogle Scholar
  13. 13.
    Umeshita K, Fujiwara K, Kiyosawa K, Makuuchi M, Satomi S, Sugimachi K, et al. Operative morbidity of living liver donors in Japan. Lancet 2003;362:687–690.CrossRefPubMedGoogle Scholar
  14. 14.
    Strong RW. Living-donor liver transplantation: an overview. J Hepatobiliary Pancreat Surg 2006;13:370–377.CrossRefPubMedGoogle Scholar
  15. 15.
    Potts M. Transplantation of the right hepatic lobe. N Engl J Med 2002;347:615–618.CrossRefPubMedGoogle Scholar
  16. 16.
    Broering DC, Wilms C, Bok P, Fischer L, Mueller L, Hillert C, et al. Evolution of donor morbidity in living related liver transplantation: a single-center analysis of 165 cases. Ann Surg 2004;240:1013–1024.CrossRefPubMedGoogle Scholar
  17. 17.
    Broelsch ChE, Frilling A, Nadalin S, Valentin GC, Kuhl H, Gerken G, et al. Living organ donor transplantation-the German experience in comparison to others. Chirurg 2003;74:510–522.CrossRefPubMedGoogle Scholar
  18. 18.
    Beavers KL, Sandler RS, Shrestha R. Donor morbidity associated with right lobectomy for living donor liver transplantation to adult recipients: a systematic review. Liver Transpl 2002;8:110–117.CrossRefPubMedGoogle Scholar
  19. 19.
    Englesbe MJ, Dimick J, Mathur A, Ads Y, Welling TH, Pelletier SJ, et al. Who pays for biliary complications following liver transplant? A business case for quality improvement. Am J Transplant 2006;6:2978–2982.CrossRefPubMedGoogle Scholar
  20. 20.
    Taketomi A, Kayashima H, Soejima Y, Yoshizumi T, Uchiyama H, Ikegami T, et al. Donor risk in adult-to-adult living donor liver transplantation: impact of left lobe graft. Transplantation 2009;87:445–450.CrossRefPubMedGoogle Scholar
  21. 21.
    Shio S, Yazumi S, Ogawa K, Hasegawa K, Tsuji Y, Kida M, et al. Biliary complications in donors for living donor liver transplantation. Am J Gastroenterol 2008;103:1393–1398.CrossRefPubMedGoogle Scholar
  22. 22.
    Gruttadauria S, Marsh JW, Vizzini GB, di Francesco F, Luca A, Volpes R, et al. Analysis of surgical and perioperative complications in seventy-five right hepatectomies for living donor liver transplantation. World J Gastroenterol 2008;14:3159–3164.CrossRefPubMedGoogle Scholar
  23. 23.
    Chan SC, Fan ST, Lo CM, Liu CL, Wong J. Toward current standards of donor right hepatectomy for adult-to-adult live donor liver transplantation through the experience of 200 cases. Ann Surg 2007;245:110–117.CrossRefPubMedGoogle Scholar
  24. 24.
    Cho EH, Suh KS, Lee HW, Shin WY, Yi NJ, Lee KU. Safety of modified extended right hepatectomy in living liver donors. Transpl Int 2007;20:779–783.CrossRefPubMedGoogle Scholar
  25. 25.
    Polido WT Jr, Lee KH, Tay KH, Wong SY, Singh R, Leong SO, et al. Adult living donor liver transplantation in Singapore: the Asian centre for liver diseases and transplantation experience. Ann Acad Med Singapore 2007;36:623–630.PubMedGoogle Scholar
  26. 26.
    Coelho JC, de Freitas AC, Matias JE, de Godoy JL, Zeni Neto C, Parolin MB, et al. Donor complications including the report of one death in right-lobe living-donor liver transplantation. Dig Surg 2007;24:191–196.CrossRefPubMedGoogle Scholar
  27. 27.
    Li FG, Yan LN, Zeng Y, Yang JY, Lin QY, Jiang XZ, et al. Donor safety in adult living donor liver transplantation using the right lobe: single center experience in China. World J Gastroenterol 2007;21;13:3752–3755.Google Scholar
  28. 28.
    Hwang S, Lee SG, Lee YJ, Sung KB, Park KM, Kim KH, et al. Lessons learned from 1,000 living donor liver transplantations in a single center: how to make living donations safe. Liver Transpl 2006;12:920–927.CrossRefPubMedGoogle Scholar
  29. 29.
    Lo CM. Complications and long-term outcome of living liver donors: a survey of 1,508 cases in five Asian centers. Transplantation 2003;75:S12–S15.CrossRefPubMedGoogle Scholar
  30. 30.
    Kim DG, Na SE, Chung ES, Moon IS, Lee MD, Kim IC. Donor safety in living donor liver transplantation using the right lobe. Transplant Proc 2003;35:53–54.CrossRefPubMedGoogle Scholar
  31. 31.
    Nadalin S, Malagó M, Testa G, Schaffer R, Sotiropoulos GC, Frilling A, et al. “Hepar divisum” as a rare donor complication after intraoperative mortality of the recipient of an intended living donor liver transplantation. Liver Transpl 2006;12:428–434.CrossRefPubMedGoogle Scholar
  32. 32.
    Yazumi S, Chiba T. Biliary complications after a right lobe living donor liver transplantation. J Gastroenterol 2005;40:861–865.CrossRefPubMedGoogle Scholar
  33. 33.
    Stapleton GN, Hickman R, Terblanche J. Blood supply of the right and left hepatic ducts. Br J Surg 1998;85:202–207.CrossRefPubMedGoogle Scholar
  34. 34.
    Huang TL, Cheng YF, Chen CL, Lee TY. Variants of the bile ducts: clinical application in the potential donor of living related hepatic transplantation. Transplant Proc 1996;28:1669–1670.PubMedGoogle Scholar
  35. 35.
    Karakas HM, Celik T, Alicioglu B. Bile duct anatomy of the Anatolian Caucasian population: Huang classification revisited. Surg Radiol Anat 2008;30:539–545.CrossRefPubMedGoogle Scholar
  36. 36.
    Cheng YF, Huang TL, Chen CL, Chen YS, Lee TY. Variations of the intrahepatic bile ducts: application in living related liver transplantation and splitting liver transplantation. Clin Transplant 1997;11:337–340.PubMedGoogle Scholar
  37. 37.
    Kitami M, Takase K, Murakami G, Ko S, Tsuboi M. Types and frequencies of biliary tract variations associated with a major portal venous anomaly: analysis with multi-detector row CT cholangiography. Radiology 2006;238:156–166.CrossRefPubMedGoogle Scholar
  38. 38.
    Ohkubo M, Nagino M, Kamiya J, Yuasa N, Oda K, Arai T, et al. Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation. Ann Surg 2004;239:82–86.CrossRefPubMedGoogle Scholar
  39. 39.
    Limanond P, Raman SS, Ghobrial RM, Busuttil RW, Lu DSK. The utility of MRCP in preoperative mapping of biliary anatomy in adult-to adult living related liver transplant donors. J Magn Reson Imaging 2004;19:209–215.CrossRefPubMedGoogle Scholar
  40. 40.
    Wietzke-Braun P, Braun F, Müller D, Lorf T, Ringe B, Ramadori G. Adult-to-adult right lobe living donor liver transplantation: comparison of endoscopic retrograde cholangiography with standard T2-weighted magnetic resonance cholangiography for evaluation of donor biliary anatomy. World J Gastroenterol 2006;12:5820–5825.PubMedGoogle Scholar
  41. 41.
    Jassem W, Heaton ND, Rela M. Reducing bile leak following segmental liver transplantation: understanding biliary anatomy of the caudate lobe. Am J Transplant 2008;8:271–274.PubMedGoogle Scholar
  42. 42.
    Wang ZJ, Yeh BM, Roberts JP, Breiman RS, Qayyum A, Coakley FV. Living donor candidates for right hepatic lobe transplantation: evaluation at CT cholangiography-initial experience. Radiology 2005;235:899–904.CrossRefPubMedGoogle Scholar
  43. 43.
    Yeh BM, Breiman RS, Taouli B, Qayyum A, Roberts JP, Coakley FV. Biliary tract depiction in living potential liver donors: comparison of conventional MR, mangafodipir trisodium enhanced excretory MR, and multidetector row CT cholangiography-initial experience. Radiology 2004;230:645.CrossRefPubMedGoogle Scholar
  44. 44.
    Song GW, Lee SG, Hwang S, Sung GB, Park KM, Kim KH, et al. Preoperative evaluation of biliary anatomy of donor in living donor liver transplantation by conventional nonenhanced magnetic resonance cholangiography. Transpl Int 2007;20:167–173.CrossRefPubMedGoogle Scholar
  45. 45.
    Kashyap R, Bozorgzadeh A, Abt P, Tsoulfas G, Maloo M, Sharma R, et al. Stratifying risk of biliary complications in adult living donor liver transplantation by magnetic resonance cholangiography. Transplantation 2008;85:1569–1572.CrossRefPubMedGoogle Scholar
  46. 46.
    Basaran C, Agildere AM, Donmez FY, Sevmis S, Budakoglu I, Karakayali H, et al. MR cholangiopancreatography with T2- weighted prospective acquisition correction turbo spin-echo sequence of the biliary anatomy of potential living liver transplant donors. Am J Roentgenol 2008;190:1527–1533.CrossRefGoogle Scholar
  47. 47.
    Mittler J, Pascher A, Jonas S, Pratschke J, Neumann UP, Langrehr JM, et al. Adult living donor liver transplantation: living donation of the right liver lobe. Langenbecks Arch Surg 2007;392:657–662.CrossRefPubMedGoogle Scholar
  48. 48.
    Ramacciato G, Varotti G, Quintini G, Masetti M, Di Benedetto F, Grazi GL, et al. Impact of biliary complications in right lobe living donor liver transplantation. Transpl Int 2006;19:122–127.CrossRefPubMedGoogle Scholar
  49. 49.
    Tamura S, Sugawara Y, Kokudo N. Donor evaluation and hepatectomy for living-donor liver transplantation. J Hepatobiliary Pancreat Surg 2008;15:79–91.CrossRefPubMedGoogle Scholar
  50. 50.
    Fan ST, Lo CM, Liu CL, Tso WK, Wong J. Biliary reconstruction and complications of right lobe live donor liver transplantation. Ann Surg 2002;236:676–683.CrossRefPubMedGoogle Scholar
  51. 51.
    Nadalin S, Bockhorn M, Malagó M, Valentin-Gamazo C, Frilling A, Broelsch CE. Living donor liver transplantation. HPB (Oxford) 2006;8:10–21.PubMedGoogle Scholar
  52. 52.
    Fan ST. Live donor liver transplantation in adults. Transplantation 2006;82:723–732.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  • Yufeng Yuan
    • 1
  • Mitsukazu Gotoh
    • 2
  1. 1.Division of Hepatobiliary Surgery, Department of Surgery, Zhongnan HospitalWuhan UniversityWuhanPR China
  2. 2.First Department of SurgeryFukushima Medical UniversityFukushimaJapan

Personalised recommendations