Safety and Efficacy of 2 N-Butyl-Cyanoacrylate as Biliostatic Agent in Living Donor Liver Transplant Recipients

Background: Despite advances in liver transplantation, biliary complications, especially after living donor liver transplantation, remain common due to complex graft anatomy. While fibrin glue has limited success in reducing these issues, N-butyl-cyanoacrylate (Glubran), a synthetic adhesive, shows promising potential.Objective: The objective of this study was to test the safety and efficacy of 2 N-butyl-cyanoacrylate as an abiliostatic agent in LDLT recipients at the HPB Surgery department at the National Liver Institute, Menoufia University. Materials and Methods: This randomized, comparative, prospective study was conducted on 50 patients undergoing LDLT. Patients were separated into two groups: Group I, comprising 25 recipients undergoing LDLT without the use of Glubran, and Group II, comprising 25 recipients undergoing LDLT with the use of Glubran. Results: Group B had significantly lower MELD, MELD-Na, and Child scores than Group A (p = 0.022). Preoperative hemoglobin, cholesterol, and triglycerides were higher in Group B (p < 0.05). Other preoperative labs, graft and ischemia parameters, biliary factors, postoperative outcomes, complications, and mortality showed no significant differences. However, blood product use (cell saver, PRBCs, FFP) was significantly lower in Group B (p < 0.05).Conclusions: The use of 2 N-butyl-cyanoacrylate reduces minor bile leak from cut surface and intraoperative blood transfusion requirements and post-operative bleeding, but no significant reduction in biliary complications (especially major leak) was observed. while 2 N-butyl-cyanoacrylate showed potential benefits in operative and post-operative haemostasis and a biliostatic agent.