UNILATERAL VERSUS BILATERAL BILIARY DRAINAGE IN PATIENTS WITH BILIARY ANASTOMOTIC STRICTURES AFTER RIGHT-LOBE LIVING DONOR LIVER TRANSPLANTATION

Aims:

Although there are usually two bile duct anastomosis sites, i.e. right anterior segment duct (RASD) and right posterior segment duct (RPSD) after in right lobe (RL)-living donor liver transplantation (LDLT), studies comparing unilateral and bilateral biliary drainage are largely lacking. This study aimed to evaluate efficacy and safety of unilateral and bilateral biliary drainage in patients with biliary strictures following RL-LDLT.

Methods:

From January 2005 to December 2017, of the 232 patients suspected to develop biliary anastomotic strictures RL-LDLT at Seoul National University Hospital, 110 patients who have two duct-to-duct anastomosis sites including RASD and RPSD were enrolled. During follow-up, ERCP was performed if biliary anastomotic strictures were suspected. Patients were classified into unilateral and bilateral biliary drainage group according to the results of first ERCP. The clinical success rate, complication rate, and 180-day mortality were compared between the unilateral and the bilateral group.

Results:

The mean age at the time of LDLT was 54.2 years. The duration from LDLT to initial biliary anastomotic strictures was 215.6 ± 187.3 days. At the initial ERCP, unilateral drainage was performed in 55 (50.0%) patients and bilateral drainage in 11 (10.0%) patients. In unilateral drainage group, endoscopic retrograde biliary drainage to RASD was predominant. (41/55, 74.5%). There was no significant difference in clinical success rate (80.0% vs. 90.9%; P = 0.669), complication rate (16.4% vs. 18.2%; P > 0.999), and 180-day mortality (1.8% vs. 0%; P > 0.999) between the unilateral and bilateral drainage group. During follow-up, 71 patients (64.5%) required bilateral drainage more than once while only 27 patients (24.5%) reached resolution with unilateral biliary drainage.

Conclusions:

Most patients required bilateral biliary drainage more than once during follow-up while only one quarter of the patients were treated with unilateral drainage. An active attempt to drain bilaterally is needed in patients with biliary anastomotic strictures following RL-LDLT.