Biliary Complications after Living Donor Liver Transplantation: Analysis of Risk Factors and Outcomes in 820 Recipients

Background: Biliary complications (BC) after LDLT continues to be an important cause of morbidity, graft loss, and mortality. Study aims to identify risk factors, analyse clinical presentations and outcome of patients with BC, and to evaluate impact of BC on survival. Methods: Retrospective analysis of 820 primary LDLTs performed at our institute between December 2011 and December 2018. With a median follow-up of 34 months (range: 1 month-95 months), the overall incidence of BC was 6.7% (n=55). Patients without BC (group A, n=765) and with BC (group B, n=55) were compared. Results: Male recipient gender (p=0.034) and sarcopenia (p-value=0.00) were statistically significant risk factors for BC on both univariate and multivariate analysis. Thirty-two (58.2%) patients presented with biliary stricture and 23 (42.8%) with biliary leak with/without stricture. Overall, 1, 3, and 5-year patient survival was significantly inferior in patients with BC (82.3%, 76.9%, and 72.1%) compared to those without BC (92.8%, 90.8%, and 90.1%). Conclusions: Sarcopenia is an important determinant of BCs after LDLT. BCs remains an important cause of patient and graft loss. Management strategies for BCs need to be tailored based on clinical presentation and available expertise at the centre.