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Hepatic Congestion-linked Intrahepatic Biliary Strictures After Living Donor Liver Transplantation

Hyun Hwa Choi1, YoungRok Choi2, Jae-Yoon Kim2

  • 1Department of Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea.

Transplantation
|July 7, 2026
PubMed

Insights

Graft hepatic congestion (GHC) is a significant risk factor for intrahepatic biliary stricture (IHBS) after liver transplants. Anatomical extent and persistence of GHC independently predict IHBS development and severity.

Area of Science:

  • Hepatobiliary Surgery
  • Transplantation Immunology
  • Surgical Complications

Background:

  • Intrahepatic biliary stricture (IHBS) is a major complication following living donor liver transplantation (LDLT).
  • Graft hepatic congestion (GHC) is suspected to contribute to IHBS, but its independent role and anatomical significance require further clarification.
  • Distinguishing GHC-related IHBS from anastomotic strictures is crucial for understanding post-transplant biliary complications.

Purpose of the Study:

  • To investigate the independent impact of anatomically defined graft hepatic congestion (GHC) on the development of intrahepatic biliary stricture (IHBS) after right-liver LDLT.
  • To assess the anatomical concordance between GHC distribution and IHBS.
  • To identify predictors of IHBS using competing risk analysis.

Main Methods:

  • Retrospective analysis of 721 adult recipients undergoing right-liver LDLT with single-duct reconstruction (2011-2018).
  • Exclusion of ABO-incompatible transplants and isolated anastomotic strictures for primary analysis.
  • Evaluation of GHC using early postoperative CT scans, categorized by anatomical extent (none, single-section, both-section).
  • Fine-Gray competing risk regression to identify independent IHBS predictors, with time-dependent analysis for congestion persistence.

Main Results:

  • Graft hepatic congestion (GHC) was frequently observed and showed a dose-dependent association with intrahepatic biliary stricture (IHBS) based on anatomical extent.
  • The spatial distribution of IHBS correlated closely with the location of GHC.
  • Increasing congestion extent and persistent GHC were independent predictors of IHBS, with higher risk for both-section congestion.
  • Patients with extensive IHBS involving both anterior and posterior sections had the poorest overall survival.

Conclusions:

  • Anatomically defined graft hepatic congestion (GHC) is a reproducible and clinically significant determinant of intrahepatic biliary stricture (IHBS) after ABO-compatible right-liver LDLT.
  • The anatomical extent and persistence of GHC are critical factors influencing IHBS development and outcomes.
  • Understanding the role of GHC can guide strategies to mitigate biliary complications in LDLT recipients.
Abstract

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