Longterm Analysis of Biliary Complications After Duct‐to‐Duct Biliary Reconstruction in Living Donor Liver Transplantations

Abstract

Biliary complication (BC) is still regarded as the Achilles' heel of a living donor liver transplantation (LDLT). This study aims to evaluate the longterm outcomes of the duct-to-duct (DD) biliary reconstruction using 7-0 suture and to identify the risk factors of BCs after LDLTs. Data of 140 LDLTs between 2006 and 2015 were analyzed. All biliary reconstructions were performed as DD anastomoses using 7-0 suture: 102 for the right lobe, 20 for the left lobe, and 18 for right posterior sector grafts. BC was defined as a bile leakage (BL) or a biliary stricture (BS), and the median follow-up time after LDLT was 65 months. A total of 19 recipients (13.5%) developed BCs (8 BLs and 16 BSs) after LDLT. The survival rates between recipients with and without BCs were 83% and 86.7%, respectively (P = 0.88). In univariate analyses, the risk factors for BC were small diameter of the graft's bile duct, long warm ischemic time, small graft-to-recipient weight ratio, and no use of external biliary stent (EBS). The graft's bile duct diameter ≤ 3 mm and no use of EBS were determined as independent risk factors (hazard ratios of 9.74 and 7.68, respectively) in multivariate analyses. The 116 recipients with EBS had no BL, 11 had BSs (9%), while 24 without EBS had 8 BLs (33%) and 5 BSs (21%). After a propensity score match between the recipients with and without EBS, the EBS group (24) developed only 1 BS (4%). In conclusion, DD anastomosis using 7-0 suture combined with EBS could provide favorable longterm outcomes after LDLT, which should thus be considered the surgical technique of choice for LDLTs.

Soehendra stent retriever for dilation of tight biliary and pancreatic duct strictures defying conventional wire‐guided endoscopic techniques: Single‐center experiences

“…None of the patients in the biliary duct group achieved successful complete stent removal until the end of follow‐up. The small recipient number with bile duct strictures after a liver transplantation in the present study resulted in the infeasibility of estimating the effects of factors relevant to graft preparations, types of anastomosis and strictures, early vs late anastomotic strictures, and post‐transplant conditions . Nonetheless, none of the patients required percutaneous or surgical interventions throughout the follow‐up timeframes.…”

Biliary complications in recipients of living donor liver transplantation: A single-centre study

“…LT is considered the only curative therapeutic option for patients with end-stage hepatic disease. Several complications, especially BC, still endanger its short and long-term outcomes[ 21 , 28 , 29 ]. Many studies have focused on BC to improve care for transplanted recipients; however, data on long-term outcomes remains scarce[ 28 ].…”

“…Duct-to-duct anastomosis (DDA) has developed into the preferred biliary reconstruction method due to its benefits of a shorter total operative time, less incidence of post-operative infections, more physiological enteric functions and the enablement of access to the biliary tree in case of complications. Roux-en-Y hepaticojejunostomy (RYHJ) is performed in the case of re-transplantation or short or diseased bile ducts[ 21 ]. However, diversity in the results regarding the superiority of both of the two biliary reconstruction and suturing techniques is still present[ 3 , 8 , 15 , 22 ].…”

Technical Advancements in Living Donor Liver Transplant

“…Certain eastern groups have shown consistent good results with transcholedochal interno-external biliary stents (90,91). Technically, an ideal DDA anastomosis avoids luminal narrowing while minimizing inter suture tissue edema.…”