Biliary Complications Requiring Interventions in Living Donor Hepatectomies: The Vanguard Multicenter Study Project of iLDLT Group

BACKGROUND: Biliary complications represent a critical concern among live liver donors in living donor liver transplantation (LDLT), often necessitating invasive interventions. This multicenter study investigated the incidence, management, and long-term outcomes of biliary complications in living donors. METHODS: Of 6532 living donors who underwent hepatectomy at 13 LDLT centers during 2013-2022, those who developed biliary complications of Clavien-Dindo classification grade IIIa or higher were retrospectively analyzed for the incidence, details of complications and managements, and long-term outcomes. RESULTS: One hundred twenty-two donors (1.9%) developed biliary complications of Clavien-Dindo classification grade IIIa or higher; biliary leakage alone (n = 87; 1.3%), biliary stricture alone (n = 18; 0.28%), combined leakage and stricture (n = 16; 0.24%), and other (bile duct transection, n = 1). The incidence was significantly higher for donors undergoing laparoscopic/robotic surgery compared with open surgery (2.9% versus 1.6%, P = 0.001). Biliary leakage was treated primarily by percutaneous drainage, whereas all biliary strictures were treated with endoscopic drainage. Redo surgery was performed for 19 donors (0.29% of all living donors; 15.6% of donors with biliary complications). Among 19 donors, 4 donors underwent hepaticojejunostomy. The median time to resolution of leakage, stricture, and combined was 1.2, 10, and 9.1 mo, respectively. Late complications required significantly longer to cure than early complications (4.0 versus 1.3 mo, P = 0.024). CONCLUSIONS: Despite the acceptably low overall incidence, the present results demonstrate that biliary complications impose a considerable burden on donors.