Risk factors and survival outcomes of biliary complications after adult-to-adult living donor liver transplantation

The objective of this study was to evaluate the risk factors and survival outcomes of biliary complications (BCs) after living donor liver transplantation (LDLT) based on our single-center experience. From 2007 to 2010, 112 adult patients were assessed. Forty-nine patients (43.8%) experienced at least one episode of BCs, including biliary stricture and bile leak, occurring in 37.5% and 16.1% of the patients, respectively. Multivariate analysis indicated that hepatic artery thrombosis (relative risk (RR), 5.692; 95% CI, 2.132 to 15.201; p<0.001), a hepatic duct diameter of less than 3mm (RR, 2.523; 95% CI, 1.295 to 4.914; p=0.005), ductoplasty (RR, 2.175; 95% CI, 1.134 to 4.174; p=0.018), and cytomegalovirus infection (RR, 4.452; 95% CI, 1.868 to 10.613; p=0.001) were independent risk factors for the development of BCs. However, these factors and BCs showed no prominent impact on the overall survival (OS) and graft survival (GS). In addition, the patients who developed vascular complications demonstrated poor outcomes in terms of OS (five-year, 56.3% vs. 78.1%; p=0.017), GS (five-year, 56.3% vs. 77.1%; p=0.023), and BC-free survival (five-year, 25.0% vs. 63.5%; p=0.007) compared with patients without vascular complications. In conclusion, BCs remain a common problem after LDLT, especially for patients using duct-to-duct anastomosis. Hepatic artery thrombosis, a short duct diameter, ductoplasty, and cytomegalovirus infection lead to an increased incidence of BCs. The occurrence of BCs manifested no significant influence on the long-term survival outcomes. However, our findings await verification through large-scale randomized studies regarding the risk factors for the development of BCs and their impact on the prognosis.