The role of intrahepatic cholangiojejunostomy in liver transplant recipients after extensive destruction of the extrahepatic biliary system.
BACKGROUND
Extensive destruction of the extrahepatic biliary system after liver transplantation can be a catastrophic event. We present our experience with the use of intrahepatic cholangiojejunostomy (IHCJ) in this setting.


METHODS
From July 1985 through December 1991, 668 liver transplantations were performed in 583 patients. Seven patients required IHCJ. This technique involves creating an anastomosis between the jejunal mucosal and hepatic parenchyma/capsule with the use of a Roux-en-Y limb of bowel. There were four adults and three children. The clinical presentation included bile leak (n = 4), subhepatic abscess (n = 2), and intrahepatic abscess (n = 1). The probable cause of these events included hepatic arterial thrombosis (n = 4), occult bile leak (n = 2), and fungal cholangitis (n = 1).


RESULTS
After IHCJ, six of the seven patients are currently alive, with a mean follow-up of 28 months. The current liver function test results include a mean bilirubin of 0.7 mg/dl (range, 0.4 to 1.9 mg/dl), serum glutamic pyruvic transaminase of 69 units/L (range, 32 to 118 units/L), and gamma-glutamyltranspeptidase of 118 IU/L (range, 111 to 265 IU/L).


CONCLUSIONS
These results suggest that IHCJ is a safe and effective alternative to retransplantation in liver recipients with extensive destruction of the extrahepatic biliary system.
Langnas
A N
AN
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
Stratta
R J
RJ
Wood
R P
RP
Ozaki
C F
CF
Bynon
J S
JS
Shaw
B W
BW
D000328:Adult; D002648:Child; D002758:Cholangiography; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007582:Jejunostomy; D016031:Liver Transplantation; D009181:Mycoses / Q000209:etiology / Q000473:pathology; D009336:Necrosis; D011183:Postoperative Complications / Q000473:pathology*; D012189:Retrospective Studies