Lab Diagnosis & Nonoperative Management of Biliary Complications in LDLT

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Laboratory Diagnosis and Nonoperative

Management of Biliary Complications in Living Donor Liver Transplant Patients.

Liver,

Pancreas and Biliary Tract

Journal

of Clinical Gastroenterology. 41(5):501-506, May/June

2007.

Venu, Mukund BA; Brown,

D. MD; Lepe, Rita MD; Berkes,

MD; Cotler, J. MD; Benedetti, Enrico

MD; Testa, Giuliano MD; Venu, Rama P. MD

Abstract:

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.

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