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Introduction Despite of the innovations in surgical and postoperative surgical treatment of donors and recipients, biliary complication is still considered to be a technical "Achilles' heel" of living donor liver transplantation (LDLT) due to the high incidence, requiring long-term interventional treatment, and potential risk for graft failure. The purpose of this study was to evaluate the effect of intraductal transanastomotic stent in reducing biliary complications after LDLT. Methods From August 2015 to February 2020, 201 adult LDLTs using right liver were enrolled. The intraductal transanastomotic stent was a silicone tube of various diameters considering the duct size. By dividing biliary complication into bile leakage and stricture, the risk factor and effect of stent were analyzed. Results In all patients with LDLT, biliary complications occurred in 54 (26.9%) patients and anastomosis site leakage occurred in 9 (9.5%) patients. Of the 201 patients, non-stent group was 101 (50.2%) patients and stent group was 100 (49.8%) patients. Anastomosis site leakage was higher in the non-stent group (n = 15, 14.9%) than in the stent group (n = 4, 4.0%, p = 0.005). Biliary stricture was also higher in the non-stent group (n = 30, 29.7%) than in the stent group (n = 17, 17.0%, p = 0.03). In multivariate analysis, hepatic artery thrombosis (p < 0.001) and intraductal stent (p = 0.01). Conclusions Intraductal transanastomotic stent can reduces biliary complications including anastomosis leakage and stricture. Further large-scale analyses of clinical data or randomized controlled trial are required to support this study.

Background: Liver transplantation (LT) has the limitation of lack of donors compared to those waiting for a transplant. Depend ing on the recipient’s condition, even liver grafts with poor conditions may need to be transplanted. This study was conducted to analyze the prognosis after LT that abandoned transplantation due to poor graft conditions at the preceding centers. Methods: From January 2010 to September 2020, deceased-donor LT was performed in 161 patients in Seoul St. Mary’s Hospi tal. Among them, 127 patients (allocated group) were preferentially allocated to our center by Korean Network for Organ Sharing and the remaining 34 patients (21.1%, abandoned group) received liver grafts that were abandoned by other transplant centers due to poor organ conditions. To compare and analyze the clinical prognosis of the allocated group and the abandoned group, various perioperative factors and postoperative outcomes were evaluated. Results: The average ages of the allocated and abandoned groups were 52.3 and 51.6 years, respectively (P=0.65). The preop erative Model for End-stage Liver Disease score was 27.3±10.6 in the allocation group and 25.8±11.3 in the abandoned group (P=0.49). There was no difference between the two groups in operation time (P=0.14) and intraoperative PRC transfusion (P=0.94). There was no difference between the two groups in intensive care unit stay (P=0.91) and hospital stay (P=0.86). In-hospital mor tality occurred in 17 patients (13.4%) in the allocated group and three patients (8.8%) in the abandoned group, so there was no dif ference between the two groups (P=0.47). The 5-year survival rate was 72.4% in the allocated group and 78.2% in the abandoned group, with no difference between the two groups (P=0.25). Conclusions: Even if the graft that was abandoned due to poor condition, good results can be obtained if the transplant is carried out according to the recipient state. And as a result, it is expected that the discarded graft can be reduced.