Treatment of vascular and biliary complications following living related-donor liver transplantation

Surgery for living related-donor liver transplantation(LRDLT) is difficult compared with orthotopic whole-liver transplantation. It is necessary to find methods both to prevent and treat vascular and biliary complications. Interventional radiological procedures have been increasingly used in recent years for the diagnosis and nonsurgical treatment of these complications, with encouraging results. Vascular complications include technical device of stricture, obstruction, and thrombosis. Hepatic arterial reconstruction requires great skill in LRDLT, although in the author's experience a surgical loupe may suffice for reconstruction in adult LRDLT if the surgeon has sufficient experience in microvascular surgery. Early postoperative life-threatening vascular complications must be treated urgently, including further surgery. Recently duct-to-duct (D-D) biliary reconstruction has been performed in addition to hepatico-jejunostomy in LRDLT. D-D anastomosis has the advantages of simple operative technique shorter duration of surgery, simple postoperative management, normal physiologic route, and elimination of reflux cholangitis.