Biliary complications following living donor hepatectomy
Braun HJ, Ascher NL, et al.Transplantation Reviews 2016; 30(4): 247-252.
Aims
To systematically review the existing literature on biliary complications in the donor following living donor hepatectomy.
Interventions
The databases PubMed and MEDLINE were searched between 2006 and 2015. Eligible studies included those published in English that reported outcomes or complications of living adult liver donors.
Participants
33 studies reporting outcomes from 12,653 donors (right lobe: 8231, left lobe: 4422) were included in this review.
Outcomes
The primary measured outcomes included biliary complications, total complications and complications requiring re-operation.
Follow-up
Not described
CET Conclusions
The authors have done a comprehensive analysis of the literature looking for the incidence and outcome of biliary complications in living donors of a portion of liver for transplantation. Only papers published between 2006 and 2015 were analysed and 33 studies were suitable to be included although, as the authors point out, there is quite a bit of overlap between reports of series from the same centre. Obviously the safety of a living donor for liver transplantation is of major importance and hence this is a particularly relevant review. The biliary complication rate range from 2% to 18% (mean 6.2%) in 12,653 donors (right lobe 8231, left lobe 4422). Only 1 donor death was reported due to a biliary complication. Over half the series used were reviews from Asia, namely Japan, Korea, China and Taiwan (and probably come from the best centres). The authors have not reported any analysis of quality of these observational studies. They also point out several limitations of their own report in that these are, overall, retrospective reviews of single centre data and as several centre specific factors influence outcome that may limit the generalised ability of these findings. The authors conclude that bile leaks and biliary strictures are still relatively common in the donor following living donor hepatectomy, but that most complications are minor and resolve with conservative measures. In their review, 9% of biliary complications required subsequent surgical intervention. The authors feel that minor variations in technique during the parenchymal transection and biliary dissection are likely to decrease further the incidence of biliary complications experienced by living donors.
Quality notes
Quality assessment not appropriate
Trial registration
None