Introduction: Fibrin sealing are used to prevent postoperative hemorrhage and biliary leakage after liver resection. We performed preliminary evaluation of the effect of topical fibrin glue applied externally to all biliary anastomosis in liver transplantation.

Materials and Methods: Between January 2011 to June 2013, fibrin glue was used in 10 patients underwent deceased donor liver transplantation (DDLT). Duct to duct anastomoses was performed in 9 of 10 patients and hepaticojejunostomy was performed in 1 patient. Biliary anastomosis was performed with 5.0 polydioxanone suture and interrupted technique. Fibrin glue injection was simply applied over the anastomosis. Biliary leakage was diagnosed when the drain fluid/serum bilirubin ratio was >5.

Results: Median age of recipients was 46.9 (28-65) and female predominance (n=8) was marked. Median MELD score of patients was 19.7 (16-26). DDLT was performed for HBV related cirrhosis (n=5), primary biliary cirrhosis (n=1), congenital hepatic fibrosis (n=1), cryptogenic cirrhosis (n=1), Wilson disease (n=1) and HBV related fulminant hepatic failure (n=1). Median age of donors was 46.6 (13-79). Three of 10 donors were considered as a marginal donor. Median operation time was 583.5 minute (360-765 min.). Median cold ischemia period of the graft was 591.5 minute (440-790 min.) and median warm ischemia period of the graft was 145.5 minute (60-360 min.). Median blood transfusion was 10.1 units (1-29 units) and median fresh frozen plasma transfusion was 11.2 units (7-27 units). Biliary leakage was observed in one patient. Leak was detected 18 days after DDLT for fulminant hepatic failure. Revision with hepaticojejunostomy was performed. Median intensive care unit stay was 4.5 days (3-7 days), and median hospital stay was 26.4 days (18-40 days). There were no peri-operative deaths. Median follow-up period was 13.5 months (1 to 30 months).

Conclusions: Fibrin sealants are effectively used as an adjunct to achieve hemostasis during liver resections. The limited evidence regarding to use of fibrin sealants for the prevention from anastomotic leaks has been published. Our initial results showed that fibrin glue would be effective in preventing biliary leakage after DDLT.