It is almost impossible to remove the element of coercion from the donor decision in this situation. As with the donor operation, complications in recipients of living donor grafts are related to the experience of the center. As experience is gained, the complication rate drops. Overall, patient and graft survival has been excellent. These complications have largely been eliminated by technical refinements, including placement of the graft in an anatomic position and employing direct vascular anastomoses without interposition grafts.
Biliary complications continue to plague the operation.
This can occasionally be managed nonoperatively with percutaneous drainage. Leakage from an unrecognized posterior segment duct may require laparotomy for repair or ligation. Leakage from the biliary anastomosis requires surgical revision, as it is a sign of inadequate blood supply to the duct. Biliary strictures may be managed using a combination of radiologic and surgical techniques. Other complications in recipients are similar to those encountered in recipients of cadaveric grafts, including but not limited to sepsis, wound infection, intra-abdominal bleeding, seizures, cerebrovascular accident, and gastrointestinal bleeding.