Duct-to-Duct Biliary Reconstruction in Adult Living-Donor Liver Transplantation

Dulundu, Ender; Sugawara, Yasuhiko; Sano, Keiji; Kishi, Yoji; Akamatsu, Nobuhisa; Kaneko, Junichi; Imamura, Hiroshi; Kokudo, Norihiro; Makuuchi, Masatoshi

doi:10.1097/01.tp.0000128912.09581.46

Cited by 105 publications

(88 citation statements)

References 28 publications

(26 reference statements)

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“…These include the much smaller size of the bile ducts, the multiplicity of the bile ducts in some grafts, the high incidence of variations in the donor biliary anatomy, the presence of a liver parenchymal cut surface, and the impaired vascularity of bile ducts secondary to the hilar dissection carried out in both donor and recipient operations. 8,19,26,27 Herein, we report a retrospective series of 120 LDLTs with an overall incidence of recipient biliary complications of 37.5%, a rate that almost coincides with rates shown in the literature.…”

Section: Discussionmentioning

confidence: 60%

Untitled

Sarhan

Osman²,

Mohamed³

et al. 2017

Exp Clin Transplant

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Objectives: Biliary complications are common after living-donor liver transplant. This retrospective study reviewed our experience with biliary complications in recipients of living-donor liver transplant. Materials and Methods: Over our 9-year study period, 120 patients underwent living-donor liver transplant. Patients were divided into 2 groups, with group A having biliary complications and group B without biliary complications. Both groups were compared, and different treatment modalities for biliary complications were evaluated. Results: Group A included 45 patients (37.5%), whereas group B included 75 patients (62.5%). Biliary complications included bile leak in 17 patients (14.2%), biliary stricture in 11 patients (9.2%), combined biliary stricture with bile leak in 15 patients (12.5%), and sphincter of Oddi dysfunction and cholangitis in 1 patient each (0.8%). Cold ischemia time was significantly longer in group A (P = .002). External biliary drainage was less frequently used in group A (P = .031). Technical success rates of endoscopic biliary drainage and percutaneous transhepatic biliary drainage were 68.3% and 41.7%. Survival rate following relaparotomy for biliary complications was 62.5%. Conclusions: Graft ischemia is an important risk factor for biliary complications. Bile leaks can predispose to anastomotic strictures. The use of external biliary drainage seems to reduce the incidence of biliary complications. Endoscopic and percutaneous transhepatic approaches can successfully treat more than twothirds of biliary complications. Relaparotomy can improve survival outcomes and is usually reserved for patients with intractable biliary complications.

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Section: Discussionmentioning

confidence: 60%

Untitled

Sarhan

Osman²,

Mohamed³

et al. 2017

Exp Clin Transplant

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“…Nevertheless, endoscopic management of biliary strictures is technically more difficult in LDLT than in DDLT, principally because of the difference in the type of graft used (partial vs whole size) and the method of biliary reconstruction. Compared to DDLT, the DD biliary anastomosis is more peripheral, smaller, and more complex in LDLT [5,16,18], and the reconstructed bile duct in LDLT is sometimes tortuous and angulated due to hypertrophy of the transplanted liver [19]. Therefore, the strategies and outcomes of endoscopic management of biliary strictures after DDLT cannot be applied to LDLT patients [13,19].…”

Section: Introductionmentioning

confidence: 98%

“…However, in recent years, duct-to-duct (DD) biliary reconstruction has been the preferred method over RYHJ [6,[14][15][16] because of its simplicity, rapid gastrointestinal recovery, lower risk of bacterial colonization of the biliary tract, and preservation of physiological bilioenteric and bowel continuity [4,15]. In addition, DD biliary reconstruction allows easier endoscopic access to the biliary system for the evaluation and management of biliary strictures following liver transplantation.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

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“…Complication rates for this anastomosis are reported up to 20% for deceased full organ liver transplantations [6][7][8]. Due to various factors (e.g., frequent variations of the bile duct anatomy and the frequent occurrence (up to 60%) of multiple biliary orifices of the right hemiliver [9][10][11]), the incidence of biliary complications (BCs) in LDLT is significantly higher [12] and frequently underestimated in the past. BCs include anastomotic complications (e.g., insufficiencies and strictures) as well as complications of the dissection of the parenchyma at the cutting surface that result in bile leakage and bilioma.…”

Section: Introductionmentioning

confidence: 98%