Abstract
BACKGROUND: Biliary complications (BCs) remain a frequent and clinically important cause of morbidity after living donor liver transplantation (LDLT), with adverse effects on graft function and long-term survival. However, evidence from Central Asia remains scarce. AIM: To evaluate the incidence, risk factors, and survival impact of BCs in adult LDLT recipients at a Central Asian centre. METHODS: This retrospective observational cohort study included 205 adult recipients who underwent living donor liver transplantation between 2011 and 2024. Biliary complications were defined based on combined clinical, biochemical, and radiological criteria. Patients were stratified according to biliary anatomy and reconstruction technique. Risk factors for biliary complications were evaluated using logistic regression analysis. Overall survival was assessed using the Kaplan-Meier method and compared between groups using the log-rank test. RESULTS: BCs developed in 50 patients (24.4%). Biliary strictures occurred in 27 patients (54.0%), bile leakage in 15 (30.0%), and combined lesions in 8 (16.0%). Multivariate analysis identified male sex (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.01-4.39; p = 0.045) and multiple bile ducts (OR 2.92, 95% CI 1.33-6.39; p = 0.008) as independent predictors of BCs. Prolonged cold ischaemia time was significant on univariate analysis but not after adjustment. Overall survival at 1, 3, and 5 years in the entire cohort was 85.7%, 81.0%, and 78.0%, respectively. Patients with BCs demonstrated reduced long-term survival compared with the overall transplant cohort, with survival rates of 93.3%, 78.3%, and 73.3% at the corresponding time points. CONCLUSION: In this Central Asian LDLT cohort, multiple bile ducts and male sex were independent risk factors for biliary complications, which were associated with poorer long-term survival. Careful preoperative biliary evaluation, preservation of ductal blood supply, and tailored reconstruction techniques are critical to reducing biliary morbidity and improving outcomes following LDLT.