Hepaticojejunostomy is a standard biliary reconstruction method for infantile living donor liver transplantation (LDLT), but choledochocholedochostomy for infants is not generally accepted yet. Ten pediatric recipients weighing no more than 10 kg underwent duct-to-duct choledochocholedochostomy (DD) for biliary reconstruction for LDLT. Patients were followed up for a median period of 26.8 months (range: 4.0-79.0 months). The incidence of posttransplant biliary complications for DD was compared with that for Roux-en-Y hepaticojejunostomy (RY). No DD patients and 1 RY patient (5%) developed biliary leakage (P Ͼ 0.05), and biliary stricture occurred in 1 DD patient (10%) and none of the RY patients (P Ͼ 0.05); none of the DD patients and 5 RY patients (25%) suffered from uncomplicated cholangitis after LDLT (P Ͼ 0.05), and 1 DD patient (10%) and 2 RY patients (10%) died of causes unrelated to biliary complications. In conclusion, both hepaticojejunostomy and choledochocholedochostomy resulted in satisfactory outcome in terms of biliary complications, including leakage and stricture, for recipients weighing no more than 10 kg. Liver Transpl 14: [1761][1762][1763][1764][1765] 2008 Liver transplantation is an established curative therapy for children with end-stage chronic liver disease or acute liver failure. Outcomes following liver transplantation for children have significantly improved over the past 2 decades because of advances in surgical procedures, preservation technology, immunosuppressants, and perioperative management. 1 However, despite refinements in surgical techniques for living donor liver transplantation (LDLT), biliary complications are still associated with significant morbidity and mortality. 2 Duct-to-duct choledochocholedochostomy (DD) and Roux-en-Y hepaticojejunostomy (RY) are now generally accepted procedures for biliary reconstruction in adult-to-adult LDLT. 3,4 However, RY has remained the standard method for pediatric LDLT because of the dominance of biliary atresia and technical difficulties related to the size and fragility of recipients' bile ducts. Only a few reports can be found in the literature on pediatric LDLT using DD, 5,6 and to the best of our knowledge, there have been no studies focused on DD for infantile LDLT. This is therefore the first report to investigate the viability of DD in LDLT for infants weighing no more than 10 kg.
PATIENTS AND METHODS
PatientsBetween February 2001 and January 2008, 57 pediatric patients (less than 15 years old) underwent 60 LDLTs at Kumamoto University Hospital. Thirty-four of these pediatric recipients (59.6%) weighed no more
Little attention has been paid to a ligation of the spontaneous portosystemic shunt in adult living donor liver transplantation (LDLT). A 33-year-old Japanese man with cryptogenic liver cirrhosis accompanied by a huge splenorenal shunt underwent LDLT. Acute cellular rejection produced "to and fro" portal venous flow on postoperative day (POD) 10. Steroid bolus therapy reversed the rejection, but the recovery of the portal venous flow was incomplete and the recipient subsequently started to have episodes of encephalopathy. Angiography showed portal hypoperfusion and portal flow steal via a huge splenorenal shunt. The patient underwent a shunt occlusion on POD 58. Portography showed marked improvement of the portal hypoperfusion. The encephalopathy thereafter dramatically reversed and the patient was discharged with no complications related to shunt ligation on POD 110. This case suggested that a ligation of a huge portosystemic shunt should therefore be considered at the time of transplantation, even when a relatively small graft is implanted.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.