Biliary anastomosis in living related liver transplantation using the right liver lobe: Techniques and complications

Abstract

Since the introduction of adult-to-adult living donor liver transplantation using the right lobe of the liver, biliary problems have led the list of complications resulting in postoperative morbidity. We report our experience with the first 30 living donor liver transplantations performed in our institution from August 1998 to January 2000. Patients were 21 men and 9 women, with a mean age 45 ؎ 16 years. Mean recipient weight was 65.1 ؎ 17.9 kg, mean graft weight was 877 ؎ 146 g, and the mean graft-recipient weight ratio was 1.5 ؎ 0.6. Patient and graft survival rates were 83.3% and 80%, respectively. Biliary anastomosis was either an end-to-end hepaticocholedochostomy with a T-drain or hepaticojejunostomy. Mean follow-up was 217.4 ؎ 149.8 days. The overall complication rate was 26.6% (8 of 30 procedures) and was directly correlated to the type of anastomosis and number of bile ducts. Surgical revision was necessary in all cases. Biliary complications were not the primary cause of graft loss. Adult living donor liver transplantation using the right lobe is a successful procedure, with graft and patient survival similar to those in cadaver full-organ transplantation. Postoperative morbidity, mainly caused by biliary leak, was directly related to the number of ducts and type of anastomosis. With increasing experience, we have better defined our plane of transection on the hilar plate, with the goal of obtaining only 1 biliary duct for the anastomosis. We also improved our parenchymal transection technique, which resulted in a decreased incidence of leak at the cut-surface area. (Liver Transpl 2000;6:710-714.)

Is Duct to Duct biliary Anastomosis the Rule in Orthotopic Liver Transplantation?

“…In our series it was 15.9 %. BC increases morbidities such as delayed postoperative recovery, prolonged hospitalization, delayed graft failure, retransplantation, and rarely death of the patient [2]. LDLT resulting in split grafts formed 30 % of patients in our series.…”

“…Hence, it is important to freshen the donor stump as short as possible to maintain adequate blood supply [6]. The high hilar dissection technique in the recipient hepatectomy ensures preservation of the blood supply [2,7,8].…”

Biliary Complications after Liver Transplantation

“…Biliary complications (BC) are frequent, increase hospital stay, cost, and operative mortality 9 . Quality of life is decreased in patients with these complications due to need of percutaneous, endoscopic and surgical procedures 23 . Even after the advances in transplant patient care and in surgical technique in t he last decades, biliary complications remain the most common postoperative technical complication.…”

Las complicaciones biliares en el trasplante hepático de donante vivo no afectan los resultados a largo plazo

“…Un aspecto en particular que parece comprometer el resultado a largo plazo de este tipo de trasplante es la elevada incidencia de complicaciones derivadas de la vía biliar 5,6 .…”

“…Aunque la existencia de este tipo de complicaciones ha sido reportada ampliamente en la literatura 5,8,14 , sus características en términos de evolución y tratamiento a lo largo del tiempo no han sido descritas específicamente todavía. Igualmente, su influencia en los resultados a largo plazo no está claramente establecida.…”