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

Abstract

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.

Pure Laparoscopic Donor Hepatectomy: A Multicenter Experience

“…Commonly, biliary complications remain a disadvantage of LDLT, with overall incidence ranging between 5% and 60% worldwide. (28)(29)(30)(31) The overall rate of major biliary complications in PLDH is comparable with that analyzed in recent previous studies performed in 2 major centers (which participated in this study). (30,31) However, PLDRH has demonstrated an increase in the risk of biliary complications in recipients.…”

Radio-Opaque Filaments Guided Bile Duct Division During Living Donor Liver Transplantation, a Simple Solution to an Ongoing Dilemma

“…The number of anastomoses performed and the number of biliary complications in the donors and recipients were not statistically significant, perhaps due to the small number of patients and low power of the present study, or due to the low overall number of complications in the this series. Similar to our findings; Arikan et al (14) and Kollmann et al (15) had reported that multiplicity of graft bile ducts was not associated with an increase in biliary complications. Both had attributed this to the recent increase in experience and improvement of surgical techniques which led to the minimization of the effect of multiple bile ducts on outcome.…”

Cystic duct anastomosis can be a viable option for biliary reconstruction in case of multiple ducts in right lobe living-donor liver transplantation

“…Muhammad et al [3] have conceded that multiple ducts have the same complication rate as single ducts in LDLT. More recently, Kollmann et al [19] and Arikan et al [20] have concluded that the number of biliary ducts and the type of anastomoses could not alter the outcome in LDLT. The BC rate of the former group at one year in multiple ducts was not significantly different from our findings (20.0% vs. 20.9%, p = 0.79).…”