The rate of biliary adverse events in duct-to-duct living donor liver transplant compared with deceased donor liver transplant

Background and aims

Living donor liver transplantation (LDLT) allows for decreased listing-to-transplant time in patients with end-stage liver disease but has been noted to be associated with higher rates of biliary adverse events. The aim of this study was to assess the adverse events of LDLT and compare them versus those of deceased donor liver transplantation (DDLT) patients.

Methods

We retrospectively reviewed patients having undergone duct-to-duct anastomosis LDLT at a single center from 2011 to 2020. Exclusion criteria included pediatric patients and LDLT with Roux-en-Y hepaticojejunostomy. Patients were then matched 1:1 with DDLT. Matching was performed by age, gender, etiology of liver disease, and Model for End-Stage Liver Disease score. Outcomes of interest included incidence of biliary strictures, bile leak, stricture recurrence rate, and the number of interventions required for stricture resolution.

Results

Fifty patients with LDLT were matched to 50 patients with DDLT. Bile leak occurred in 14 (38%) patients in the LDLT group versus 5 (10%) patients in the DDLT group (P = .001). Biliary strictures occurred in 14 (28%) versus 15 (30%) patients in the LDLT and DDLT groups, respectively (P = .68). There was no difference in the median (interquartile range) number of interventions required to resolve the strictures (3 [2-6] vs 4 [3-5]; P = .79]. Three patients in each group had recurrence of strictures after documented resolution. Mortality in both groups were similar (5 [10%] patients in the LDLT group vs 6 [12%] in the DDLT group; P = .75).

Conclusions

Patients who underwent LDLT were equally as likely to develop anastomotic strictures compared with DDLT. Duct-to-duct anastomosis LDLT should be frequently considered in patients with end-stage liver disease with favorable anatomy.