Risk Factors for Biliary Complications Post Living Donor Liver Transplantation

Abstract

Living donor liver transplantation (LDLT) represents the majority of all liver transplantations in countries where great shortage of deceased donor organs is present. For the last decade, the innovation of surgical procedures and perioperative managements of living donors and recipients have made the LDLT a worldwide popular procedure and a major treatment modality, such as for end-stage liver disease, hepatocellular carcinoma, and acute liver failure. Despite widespread dissemination of the method, biliary complications (BCs) are considered the technical “Achilles heel” of LDLT, due to their high incidence and the potential risk of graft failure, requiring long-term interventional management (Sung et al., 2018). Biliary system complications following LDLT remain a significant cause of morbidity and mortality, and affect up to 30% of recipients. To prevent the onset of BCs, various risk factors were identified in previous studies, such as a high MELD score, advanced donor age, longer cold ischemia time, and hepatic artery thrombosis (Nakamura et al., 2017). A study done by Ye et al., in 2004 proved that biliary complications after liver transplantation have been related to many conditions, including prolonged cold ischemic time, hepatic artery thrombosis, ABO blood type incompatibility, cytomegalovirus infection, recurrence of primary disease, the use of reduced-size liver transplants, and the method of biliary