Department of Radiology, Inonu University Faculty of Medicine, Malatya, Turkey.
Department of General Surgery, Inonu University Faculty of Medicine, Malatya, Turkey.
Diagn Interv Radiol. 2021 Jul;27(4):546-552. doi: 10.5152/dir.2021.20523.
Biliary complications develop at a higher rate in living donor liver transplantation (LDLT) compared with cadaveric liver transplantation. Almost all studies about biliary complications after LDLT were made with the right lobe. The aim of this study was to determine the frequency of biliary complications developing after adult left lobe LDLT and to evaluate the efficacy of the algorithm followed in diagnosis and treatment, particularly percutaneous radiological treatment.
A total of 2185 LDLT operations performed in our center between May 2009 and December 2019 were retrospectively reviewed and patients receiving left lobe LDLT were analyzed regarding biliary complications and treatments. Biliary complications were treated via percutaneous drainage under ultrasound (US) guidance, endoscopic retrograde cholangiopancreatography (ERCP), and percutaneous transhepatic cholangiography (PTC)/ percutaneous transhepatic biliary drainage (PTBD). Patient demographics, ERCP procedures before percutaneous treatment, and percutaneous treatment indications were analyzed.
A total of 69 adult patients received left lobe LDLT. Biliary complications requiring endoscopic and/or percutaneous treatment developed in 28 patients (40%). Of these patients, 4 had bile leakage (14%), 20 had anastomosis stricture (72%), and 4 had both leakage and anastomosis stricture (14%). External drainage treatment under ultrasound guidance was sufficient for 2 of 4 patients with bile leakage, and these cases were accepted as minor bile leakage (7%). Overall, 26 patients underwent ERCP; of these, 8 were referred for PTC/PTBD because the guidewire and/or balloon-stent could not pass the anastomosis stricture (n=7) and common bile duct cannulation could not be obtained because of duodenal diverticulum (n=1). Diagnostic PTC was performed in 10 patients, 8 were referred after inadequate/failed ERCP procedure and two were referred directly without ERCP. Anastomosis stricture was found in 7 patients and anastomosis stricture and bile leakage in 3. In 7 patients determined to have stricture, balloon dilatation was applied and then biliary drainage was performed. In 3 patients who had leakage and anastomosis stricture, balloon dilatation was applied for stricture; after dilatation, an IEBD catheter was placed through the leakage region in 2 patients, while a covered metallic stent passing through the leakage region was placed in one patient.
Generally, ERCP is the first preferred method in biliary complications of LDLT; however, in cases where a response cannot be obtained by endoscopic treatment or require complex and/or aggressive treatment, percutaneous radiological treatment should be the treatment of choice before surgery in left lobe LDLT.
与尸体供肝肝移植相比，活体供肝肝移植（LDLT）发生胆道并发症的发生率更高。几乎所有关于 LDLT 后胆道并发症的研究都是使用右叶进行的。本研究旨在确定成人左叶 LDLT 后胆道并发症的发生率，并评估诊断和治疗方案的疗效，特别是经皮放射治疗。
回顾性分析 2009 年 5 月至 2019 年 12 月期间在我中心进行的 2185 例 LDLT 手术，分析接受左叶 LDLT 的患者胆道并发症和治疗情况。胆道并发症采用超声（US）引导下经皮引流、内镜逆行胰胆管造影术（ERCP）和经皮肝穿刺胆管造影术（PTC）/经皮肝穿刺胆道引流术（PTBD）进行治疗。分析患者的人口统计学资料、经皮治疗前 ERCP 操作及经皮治疗适应证。
共有 69 例成人接受左叶 LDLT。28 例（40%）患者需要内镜和/或经皮治疗胆道并发症。这些患者中，4 例有胆漏（14%），20 例有吻合口狭窄（72%），4 例同时有胆漏和吻合口狭窄（14%）。4 例胆漏患者中有 2 例经 US 引导下的外部引流治疗即可，这 2 例被认为是轻微胆漏（7%）。总体而言，26 例患者接受了 ERCP；其中 8 例因导丝和/或球囊扩张导管无法通过吻合口狭窄（n=7）和十二指肠憩室导致无法获得胆总管插管（n=1）而转至 PTC/PTBD。10 例患者行诊断性 PTC，8 例在 ERCP 操作不足/失败后转至该治疗，2 例直接转至该治疗而未行 ERCP。7 例患者发现吻合口狭窄，3 例发现吻合口狭窄伴胆漏。在 7 例确定为狭窄的患者中，应用球囊扩张术，然后进行胆汁引流。在 3 例同时存在胆漏和吻合口狭窄的患者中，对狭窄部位应用球囊扩张术；扩张后，2 例患者通过漏口部位放置了 IEBD 导管，1 例患者放置了通过漏口的带膜金属支架。
一般来说，ERCP 是 LDLT 胆道并发症的首选方法；然而，在经内镜治疗无法获得疗效或需要复杂和/或激进治疗的情况下，在左叶 LDLT 手术前，经皮放射治疗应作为首选治疗方法。
