Biliary complications following donation after brainstem death liver transplantation

doi:10.4240/wjgs.v18.i1.112906

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Jan 27, 2026 (publication date) through Jan 28, 2026

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Jan 27, 2026; 18(1): 112906
Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.112906

Biliary complications following donation after brainstem death liver transplantation

Rawan Al-Rubaye, Mohamed Elshaer, Karim R Moawad, Rohit Gaurav

Rawan Al-Rubaye, Mohamed Elshaer, Karim R Moawad, Rohit Gaurav, Department of Hepato-Pancreato-Biliary and Transplantation Surgery, Cambridge University Hospitals, Addenbrooke’s Hospital, Cambridge CB2 0QQ, Cambridgeshire, United Kingdom

Co-first authors: Rawan Al-Rubaye and Mohamed Elshaer.

Author contributions: Al-Rubaye R and Elshaer M analyzed the data and wrote the manuscript; Elshaer M performed the research; Moawad KR and Gaurav R revised and critically appraised the manuscript; Al-Rubaye R and Elshaer M contributed equally to this manuscript and are co-first authors. All authors have read and approved the final manuscript.

Institutional review board statement: This retrospective study was conducted in accordance with the Declaration of Helsinki and local institutional guidelines. Given the retrospective nature of the study using anonymized data from routine clinical care, formal ethical approval from the Research Ethics Committee/institutional review board was not required under United Kingdom research governance frameworks.

Informed consent statement: Given the retrospective nature of the study using anonymized data from routine clinical care, informed consent was not required under United Kingdom research governance frameworks.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Mohamed Elshaer, MD, FRCS (Gen Surg), Department of Hepato-Pancreato-Biliary and Transplantation Surgery, Cambridge University Hospitals, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, Cambridgeshire, United Kingdom. mohamed.elshaer@nhs.net

Received: August 27, 2025
Revised: October 20, 2025
Accepted: November 11, 2025
Published online: January 27, 2026
Processing time: 166 Days and 2.1 Hours

Core Tip

Core Tip: This retrospective study of 366 liver transplant after brainstem death, demonstrates that anastomotic biliary stricture remains a significant complication, occurring in 10.7% of patients. Roux-en-Y hepaticojejunostomy (RYHJ) was associated with significantly lower rates of bile leaks and anastomotic strictures compared to duct-to-duct anastomosis. However, patients undergoing primary RYHJ had higher reoperation and re-transplantation rates, primarily due to selection bias, as RYHJ was preferentially performed in patients with complex recipient pathology. Early detection and appropriate management with a stepwise approach - from endoscopic intervention to surgical revision - are crucial for optimizing post-transplant outcomes.