Impact of biliary complications in right lobe living donor liver transplantation.

Biliary reconstruction is one of the most challenging parts of right lobe living donor liver transplantation (RL LDLT), and biliary complications have been reported as the first source of surgical complications of this procedure. We reviewed biliary reconstruction and complications in 27 consecutive RL LDLTs. We compared the first 14 procedures (group 1) to the last 13 (group 2). Seven patients (25.9\%) experienced a biliary complication (five leaks and two strictures). The incidence of biliary complications was 11.1\% in RL grafts with a single duct and 55.5\% in graft presenting multiple bile ducts (P = 0.03). Four of the 18 patients with a duct-to-duct reconstruction (22.2\%) and three of the 11 patients with a Roux-en-Y reconstruction (27.3\%) developed a biliary complication (P = ns). The incidence of biliary complications significantly decreased from 42.9\% (n = 6) in the first group to 7.6\% (n = 1) in the second group (P = 0.05). The overall 1-year graft and patient survival were 57.1\% and 64.3\% in group 1 versus 100.0\% and 100\% in group 2 (P = 0.01; P = 0.006). Biliary complications remain one of the most important technical complications affecting RL LDLT. Nevertheless, attention and surgical refinement can lead to a significant reduction of the biliary complication rate, improving graft and patient survival.