Spectrum of biliary complications following live donor liver transplantation

Table 1 Clavien system for classification of complications in general surgery and solid organ transplantation

Grade 1	Any alteration from the ideal postoperative course, with complete recovery or which can be easily controlled and which fulfills the following general characteristics:
	(1) Not life threatening
	(2) Not requiring use of drugs other than immunosuppressants, analgesics, antipyretics, anti-inflammatory agents, antiemetic, drugs required for urinary retention or lower urinary tract infection, arterial hypertension, hyperlipidemia or transient hyperglycemia
	(3) Requiring only therapeutic procedures that can be performed at the bedside
	(4) Postoperative bleeding requiring ≤ 3 units of blood transfusion
	(5) Never associated with a prolongation of ICU stay or total hospital stay to more than twice the median stay for the procedure in the population of the study
Grade 2	Any complication that is potentially life threatening or results in ICU stay > 5 d, hospital stay > 4 wk for the recipient, but which does not result in residual disability or persistent disease
Grade 3	Any complication with residual or lasting functional disability or development of malignant disease
Grade 4	Complications that lead to re transplantation (grade 4a) or death (grade 4b)

ICU: Intensive care unit.

Table 2 Biliary complications in recipients after live donor liver transplantation

Ref.	Year	Country	Grafts (n)		Biliary complications (%)
			Right	Left	Leaks	Strictures	Overall rate
Ghobrial et al[22]	2001	United States	20		25	-	-
Gondolesi et al[23]	2004	United States	96	0	21.9	22.9	40.6
Liu et al[24]	2004	China	41	0	7.3	24.3	24.3
Giacomoni et al[25]	2006	Italy	23	0	21.7	21.7	34.8
Soejima et al[26]	2006	Japan	50	132	11.5	25.3	36.8
Shah et al[27]	2007	Canada	128	0	14.8	17.1	26.0
Mita et al[28]	2008	Japan	5	226	-	9.5	-
Freise et al[7]	2008	United States (A2ALL)	384	0	27.2	18	35.5
Marubashi et al[29]	2009	Japan	57	26	1.2	7.2	8.4
Lin et al[30]	2009	China	-	-	-	-	8.9
Wadhawan et al[31]	2010	India	338	0	8.8	10.3	19
Kim et al[32]	2010	South Korea	22	0	0	9.1	9.1
Soin et al[14]	2010	India	218	26	2	3.7	5

Table 3 Incidence of biliary complications in donors after live donor liver transplantation

Ref.	n	Graft type	Leak (%)	Stricture (%)	Overall rate (%)
Iida et al[76]	500	Right	10.6	1.6	12.2
	762	Left	4.7	0.3	4.9
El-Meteini et al[77]	207	Right	22	1.6	13.04
Taketomi et al[78]	69	Right	-	-	10.1
	137	Left	-	-	2.9
Lo et al[79]	561	Right	6.1	1.1	7.1
	939	Left
Shio et al[75]	434	Right	9.9	2.1	11.1
	297	Left	1.7	1	2.4
Ghobrial et al[72]	393	Right	9	0.5	9.6
Ozgor et al[74]	500	Right	-	-	10.8
		Left
European Liver	276	Right	5	3	8
Transplant Registry[80]		Left