Biliary Reconstruction and Complications in Adult Living Donor Liver Transplantation: Systematic Review and Meta-analysis

Zhang, S.; Zhang, M.; Xia, Qiang; Zhang, J.-J.

doi:10.1016/j.transproceed.2013.05.014

Cited by 37 publications

(18 citation statements)

References 32 publications

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“…Although Roux‐en‐Y reconstruction has been the standard technique at the beginning of LDLT, DD anastomosis has become more frequent over time due to a shorter operation time, a more physiologic enteric function, and the option for endoscopic access to the biliary tract when needed . It is not clear yet which reconstruction technique is superior for LDLT . In a large analysis published in 2006, Kasahara et al evaluated the outcome of 321 patients who received right lobe LDLT and compared biliary complication rates between those receiving DD anastomosis versus Roux‐en‐Y reconstruction .…”

Section: Discussionmentioning

confidence: 99%

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Living Donor Liver Transplantation Using Selected Grafts With 2 Bile Ducts Compared With 1 Bile Duct Does Not Impact Patient Outcome

Kollmann¹,

Goldaracena²,

Sapisochín³

et al. 2018

Liver Transpl

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The outcome after living donor liver transplantation (LDLT) using grafts with multiple bile ducts (BDs) remains unclear. We analyzed 510 patients who received an adult‐to‐adult right lobe LDLT between 2000 and 2015 and compared outcome parameters of those receiving grafts with 2 BDs (n = 169) with patients receiving grafts with 1 BD (n = 320). Additionally, patients receiving a graft with 3 BDs (n = 21) were analyzed. Demographic variables and disease severity were similar between the groups. Roux‐en‐Y reconstruction was significantly more common in the 2 BD group (77% versus 38%; P < 0.001) compared with the 1 BD group. No difference was found in biliary complication rates within 1 year after LDLT (1 BD versus 2 BD groups, 18% versus 21%, respectively; P = 0.46). In the 2 BD group, 82/169 (48.5%) patients were reconstructed with 2 anastomoses. The number of anastomoses did not negatively impact biliary complication rates. Recipients’ major complication rate (Clavien ≥ 3b) was similar between both groups (1 BD versus 2 BD groups, 21% versus 24%, respectively; P = 0.36). Furthermore, no difference could be found between the 1 BD, the 2 BD, and the 3 BD groups in the frequency of developing biliary complications within 1 year (18%, 21%, 14%, respectively; P = 0.64), BD strictures (15%, 15%, 5%, respectively; P = 0.42), or BD leaks (10%, 11%, 10%, respectively; P = 0.98). In addition, the 1‐year (90% versus 91%), 5‐year (82% versus 77%), and 10‐year (70% versus 66%) graft survival rates as well as the 1‐year (92% versus 93%), 5‐year (84% versus 80%), and 10‐year (75% versus 76%) patient survival rates were comparable between the 1 BD and the 2 BD groups (P = 0.41 and P = 0.54, respectively). In conclusion, this study demonstrates that selected living donor grafts with 2 BDs can be used safely without negatively impacting biliary complication rates and graft or patient survival rates.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, living donor liver transplantation (LDLT) has developed into a well‐recognized treatment option for patients with ESLD with results comparable to those achieved with deceased donor grafts . This has been attributed to a continuous improvement of surgical techniques, immunosuppressive management, and organ preservation …”

mentioning

confidence: 99%

Living Donor Liver Transplantation Using Selected Grafts With 2 Bile Ducts Compared With 1 Bile Duct Does Not Impact Patient Outcome

Kollmann¹,

Goldaracena²,

Sapisochín³

et al. 2018

Liver Transpl

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“…A review article and a metaanalysis investigating biliary complications and recon struction outcomes found similar outcomes for duct-to-duct anastomosis and hepaticojejunostomy anastomosis. 21 They recom mended that the choice of anastomosis type be based on anatomic and personal characteristics of a patient. Vascular anatomy of the donor, localization of bile ducts relative to the portal vein, and the number and diameter of bile canals are important risk factors for biliary complications developing after transplant.…”

Section: Discussionmentioning

confidence: 99%

Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant

Tezcaner¹,

Dinc²,

Karakayalı³

et al. 2019

Exp Clin Transplant

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Objectives: Our aim was to evaluate the influence of the localization of right posterior bile duct anatomy relative to portal vein of the donors on posttransplant bile duct complications. Materials and Methods: We retrospectively investigated 141 patients who had undergone living donor liver transplant using right hemiliver grafts. The patients were classified based on the pattern of the right posterior bile duct and divided into infraportal and supraportal types. Clinical donor and recipient risk factors and surgical outcomes were compared for their relationship with biliary complications using logistic regression analyses. Results: The 2 groups were similar according to demographic and clinical features. The biliary complication rate was 23.7% (9/38) in the infraportal group and 47.4% (37/78) in the supraportal group (P = .014). An analysis of risk factors for the development of anastomotic bile leak using logistic regression showed that a supraportal right posterior bile duct anatomy was a statistically significant positive predictor, with odds ratio of 18.905 (P = .012; confidence interval, 1.922-185.967). The distance of the right posterior bile duct from confluence was significantly lower in patients with biliary complications than in those without (mean of 7.66 vs 0.40 mm; P = .044). According to receiver operating characteristic analyses, the cutoff point for the length of right bile duct to right posterior bile duct from the hepatic confluence was 9.5 mm regarding presence of complications. Conclusions: Factors influencing bile duct anastomosis leakage were supraportal-type donor bile duct anatomy and length of the right main bile duct from biliary confluence. Hepatic arterial complications were similarly a risk factor for biliary strictures. Because of the multiple factors leading to complications in living donor liver transplant, it is challenging to group these patients by operative risk; however, establishing risk models may facilitate the prediction of complications.

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“…The mean incidence of BTC in LDLT is 36% (ranging from 20 to 60%; an incidence double of that seen in DDLT) from 20% to 60%. This high incidence is related to the quality of the preoperative and intraoperative biliary imaging, the ischemic damage of the bile duct stumps during the donor hepatectomy, and last but not least the number and size of bile ducts to anastomosis …”

Section: Btc and Living Donor Liver Transplantation (Ldlt)mentioning

confidence: 99%

Biliary tract complications and its prevention

Lerut

2015

Liver Transpl

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Biliary Reconstruction and Complications in Adult Living Donor Liver Transplantation: Systematic Review and Meta-analysis

Cited by 37 publications

References 32 publications

Living Donor Liver Transplantation Using Selected Grafts With 2 Bile Ducts Compared With 1 Bile Duct Does Not Impact Patient Outcome

Living Donor Liver Transplantation Using Selected Grafts With 2 Bile Ducts Compared With 1 Bile Duct Does Not Impact Patient Outcome

Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant

Biliary tract complications and its prevention

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