What are the possible complications of living-donor liver transplantation (LDLTX)?

Updated: Nov 11, 2019
  • Author: Fazal Hussain, MD, MPH; Chief Editor: John Karani, MBBS, FRCR  more...
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Complications following living-donor liver transplantation (LDLTX) are essentially identical to those of whole-liver orthotopic liver transplantation (OLTX). The major problems encountered include biliary stenosis, bile leaks, HAS, and HAT. [39] Like OLTX, recurrent hepatocellular disease can affect LDLTXs. Imaging LDLTX complications is analogous to imaging in patients with OLTX.

With LDLTXs, anastomosed bile ducts are necessarily smaller, representing a greater technical challenge. End-to-end bile duct reconstruction is often possible, and in other cases, biliary-enteric anastomosis is performed. As with OLTXs, biliary stricture can occur. Additionally, bile leaks in the donor and in the recipient can result if anomalous ducts crossing the plane of section in the donor liver are not recognized by preoperative imaging or at surgery. Bilomas can form from weeping of the cut liver surfaces, probably because small radicles are coagulated incompletely. As with other fluid collections, LDLTX bilomas can become superinfected.

Hepatic artery stenosis (HAS) and thrombosis (HAT) also can occur after LDLTX. The small caliber of the donor right hepatic artery increases the possibility of subsequent arterial complication. The necessity for multiple anastomoses in patients with anomalous branching of the right hepatic artery compounds the potential.

Aberrant hepatic venous and portal venous anatomy can increase the difficulty of performing LDLTXs compared with that of performing OLTXs. However, thorough preoperative imaging and careful surgical dissection allow aberrations in the HV and PV to be identified and dealt with satisfactorily. Significant venous problems are unusual after LDLTX.

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