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Laboratory Diagnosis and Nonoperative Management of Biliary Complications in Living Donor Liver Transplant Patients

Venu, Mukund, BA; Brown, Russell D., MD; Lepe, Rita, MD; Berkes, Jamie, MD; Cotler, Scott J., MD; Benedetti, Enrico, MD; Testa, Giuliano, MD; Venu, Rama P., MD

Journal of Clinical Gastroenterology: May-June 2007 - Volume 41 - Issue 5 - p 501-506
doi: 10.1097/01.mcg.0000247986.95053.2a
Liver, Pancreas and Biliary Tract: Clinical Research
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Background Biliary complications associated with living donor liver transplantation (LDLT) remain a major problem. Information regarding biochemical abnormalities helpful for the diagnosis and the nonoperative management of such complications are limited.

Methods Adult patients who underwent LDLT were retrospectively studied for biliary complications. Clinical findings and laboratory studies, that is, serum bilirubin, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase were evaluated. Diagnostic percutaneous transhepatic cholangiogram or endoscopic retrograde cholangiogram followed by therapeutic interventions such as endoscopic sphincterotomy, stone extraction, balloon dilation, or stent placement were done as indicated. Follow-up data on clinical and biochemical outcomes were assessed.

Results Among the first 29 patients who underwent LDLT, 7 patients (24%) developed biliary complications. Nonoperative treatment was undertaken through endoscopic retrograde cholangiogram in 4 cases, percutaneous transhepatic cholangiogram in 3 cases with a successful clinical outcome in 6 cases (84%). All patients with biliary stricture had a bilirubin level >1.5 mg/dL with 100% sensitivity.

Conclusions A number of patients developed biliary complications after LDLT. Nonoperative treatments were successful in most patients. Elevated serum bilirubin level may be helpful in the diagnosis of biliary stricture complicating LDLT.

Digestive Disease and Nutrition, Hepatology, and Transplantation, University of Illinois Medical Center at Chicago, Chicago, IL

Reprints: Rama P. Venu, MD, 840 S. Wood St (M/C 716), Chicago, IL 60612 (e-mail: ramapvenu@yahoo.com).

Received for publication April 17, 2006; accepted September 13, 2006

© 2007 Lippincott Williams & Wilkins, Inc.