الفهرس 
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Abstract
Living donor liver transplantation (LDL T) has become an important tool to treat end stage liver disease due to the lack of cadaveric donors. The incidence of biliary complications after LDL T is still high in spite of improvements of immunosuppression, organ preservation, intraoperative management, and refinements of surgical technique.
The aim of this study was to characterize the features of biliary complications that occur after right-lobe living-donor liver transplantation (RL-LDL T) with duct-to-duct biliary reconstruction and to evaluate the efficacy of treating these biliary complications endoscopically.
Between January 2005 and January 2007, 141 patients underwent Right- Lobe Living Donor Liver Transplantation (RL-LDL T) with ducttto-duct biliary anastomosis at Kyoto University Hospital, Kyoto, Japan. These patients were followed up for 6-30 months
Of 141 patients, 45 developed biliary complications .The patients were 31 males and] 4 females, with a median age of 49.84 ± 12.0 years, Median model for end-stage liver disease score was 18.05 ± 6.86 The indication for liver transplantation was viral hepatitis in 28 patients, (HCV n = 17, HBV n = 11), cholestatic liver disease (n = 3), fulminant hepatic failure (n =7), Alcoholic liver disease (n = 2) and others (n = 7). Concomitant hepatocellular carcinoma present in 21 patients.
ERC was performed at an average of 162 days (range, 14-543 days) after RL-LDLT and an average of 2.9 and range 1-8 times per patient. ERC disclosed biliary stricture in 42 (29.78%) of the 141 patients; 41 (29.07%) of the strictures were anastomotic and one (0.07%) were non-anastomotic.
The strictures in 35 of these patients were successfully treated with inside stents. These patients treated by placing up to three of the inside stents endoscopically above the sphincter of Oddi. The average number of stents inserted per patient was 1.8 (range, 1 to 3) and the average size
of the inside stents was 9.2F (range, 7F to 12F). Within a week after stenting, 4 patients developed acute cholangitis.
Finally, in 31 (75.6%) of the 41 patients surgical conversion was avoided by endoscopic treatment.
Within 3 months after the insertion of the stents as shown in table 8, the serum level of total bilirubin significantly improved from 6.2±5.05 mg/dL to 0.8 ±0.2 mg/dL, serum alkaline phosphatase (ALP) level improved from 318.71±95.64 U/L to 105.28 ±20.08U/L and serum gamma glutamyl transferase (GGTP) level improved from 179.97±36.56U/L to 97.06 ±11.45U/L
Three patients had anastomotic strictures that were characterized by a severely bent common bile duct that looked like a crane neck and one patient developed non anastomotic stricture due to recurrence of primary sclerosing cholangitis (PSC) and treated by retransplantation because of diffuse intrahepatic biliary strictures.
Biliary leakage developed at the site of the biliary anastomosis in 6 (4.25%) of the 141 patients, including 3 of the patients who had a biliary stricture, at an average of38.8 days (range, 14-80 days) after RL-LDLT.
Biliary stones, sludge, or casts developed in 7(4.96 %) of the 141 patients, and all were removed endoscopically after endoscopic papillary balloon dilation. All these patients also had a biliary stricture.
Ampullary dysfunction present in 3 patients (2.1 %) and treated by endoscopic papillary balloon dilation (EPBD).