Biliary reconstruction for infantile living donor liver transplantation: Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedochostomy?

Abstract

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

Bile duct anastomotic stricture after pediatric living donor liver transplantation

“…Nonetheless, in the present study, we found that DDA was associated with a significantly higher rate of BAS when compared with HJ. This result conflicts with what was reported by a previous study [15]. We believe that, at least when pediatric patients are concerned, the advantages and potential benefits of DDA cannot balance out its potential detriment.…”

Single-center experience and long-term outcomes of duct-to-duct biliary reconstruction in infantile living donor liver transplantation

“…Several programs have reported that DD biliary reconstruction leads to more biliary complications in comparison with RY hepaticojejunostomy, especially in small infants weighing less than 10 kg . In our experience, however, DD reconstruction for pediatric cases, including infants, has led to excellent outcomes during the short‐term follow‐up period . In the present study, long‐term outcomes were evaluated for DD biliary reconstruction versus RY hepaticojejunostomy in pediatric recipients with a body weight less than 10 kg at the time of transplantation.…”

Biliary complications after living donor liver transplantation

“…More and more transplant surgeons are realizing that stenting may be the best compromise for reducing the chance of leaks and maintaining the patency of the duct anastomosis only when the ductal orifice is small (eg, 2 mm) 68. Accordingly, in an increasing number of transplant centers, stents are used only for pediatric patients or RY patients, who usually have small bile ducts 23, 66, 69, 70. A prospective randomized trial is needed to definitively settle the controversy.…”