*Purpose: Endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) may be performed in patients with anastomotic biliary complications (ABC) after living donor liver transplantation (LDLT). This study evaluated the optimal intervention for patients with ABC after LDLT.

*Methods: Prospectively collected data of patients who were diagnosed with ABC after LDLT between January 2013 and June 2017 were retrospectively reviewed.

*Results: There were 57 patients who underwent LDLT with a right liver graft using duct-to-duct biliary reconstruction and experienced ABC. Among the patients with RAD involvement, there were no significant differences in the intervention success (82.8% vs. 66.7%; P = 0.271) and patency (115 ± 40.4 days vs. 126 ± 28.3 days; P = 0.267) rates between ERCP and PTBD. Similarly, among the patients with RPD involvement, there were no significant differences in the intervention success (47.6% vs. 70.0%; P = 0.148), and patency (176 ± 29 days vs. 283 ± 74.6 days; P = 0.754) rates between the two procedures. Graft bile duct variation (P = 0.013) and a large angle between the recipient and graft bile duct (R-G angle) (P = 0.012) increased the likelihood of failure of ERCP in the RAD. When R-G angle was greater than 47.5°, the likelihood of failure of ERCP was increased.

*Conclusions: Both ERCP and PTBD are appropriate as first-line treatments for ABC after LDLT. Specifically, PTBD would be preferred when graft bile duct variation is presented in the patients with RAD involvement and/or when R-G angle is greater than 47.5°.

« Back to 2022 American Transplant Congress