PERCUTANEOUS TREATMENT OF BILE LEAKAGE AFTER LIVING DONOR LIVER TRANSPLANTATION

Abstract

Objective: Biliary leakage (BL) is one of the most frequent complications following living donor liver transplantation (LDLT). Radiological methods are important in diagnosis and treatment. Although endoscopic approaches are considered as the first-line treatment option in BL, nowadays, increasing experience is strengthening the role of interventional radiological approaches. In our article, we aim to analyze our experience in the diagnosis and treatment of BLs developed after LDLT. Material and methods: Between January 2015 and December 2018, 361 LDLT cases performed consecutive at our center were analyzed retrospectively. The leakage diagnosis and location was demonstrated by magnetic resonance cholangiopancreatography (MRCP) with hepatobiliary excreted contrast agent gadoxetate disodium in patients with suspected leakage. BLs were treated by endoscopic, interventional radiological, surgical or conservative approaches. Results: Of the total 361 cases, 27 (7.4\%) had BL. Twenty six (96\%) of the BL were anastomotic and 1 (3,7\%) was incision surface leakage. One patient (3.7\%) was treated by endoscopic sphincterotomy methods, 23 (85,1\%) patients by interventional radiological approaches, two patients (7.4\%) by surgery and 1 patient (3,7\%) by conservative approaches. There were no minor and major complications during interventional radiological procedures. After the procedure, minor complications (mild cholangitic attack) in 4 (17.4\%), mild edematous pancreatitis in 2 (8,6\%) developed in 6 (26\%) patients. Conclusion: Endoscopic treatment approaches may be complicated in patients with multiple anastomosis of biliary tract after LDLT. Although interventional radiological approaches require experience, they can be performed as an alternative treatment method.