title: Biliary reconstruction and complications of right lobe live donor liver transplantation.
abstract: OBJECTIVE
  To identify the possible reasons of failure of biliary reconstruction in right lobe live donor liver transplantation (LDLT) and to devise the best method of reconstruction and treatment strategy for the complications.
  
  
  BACKGROUND
  Right lobe LDLT was associated with a high biliary complication rate (15-64%) in the reported series. The causes of failure were not completely understood and the best treatment strategy has not been defined.
  
  
  METHODS
  From 1996 to 2001, 74 patients received right lobe LDLT. The operative procedures of the first 37 patients were critically reviewed to identify the possible reasons of leakage or stenosis from the anastomosis. The causes included right hepatic duct ischemia, double or triple hepaticojejunostomies, unrecognized branch of right hepatic duct, jejunal opening smaller than the size of right hepatic duct, and ductal plasty without division of newly created septum. The second 37 patients had biliary reconstruction by a modified technique that preserved blood supply to the right hepatic duct and aimed at avoidance of risk factors.
  
  
  RESULTS
  The overall complication rate decreased from 43% in the first 37 patients to 8% in the second 37 patients. There was no leakage from the anastomosis in the second group of patients. Percutaneous transhepatic biliary drainage (PTBD) for the biliary complications resulted in right portal vein and hepatic artery injury in four patients and accounted for mortality in three of them. To avoid complications from PTBD, three patients in the second group developing stenosis of hepaticojejunostomy had repeated hepaticojejunostomy without preoperative PTBD and recovered.
  
  
  CONCLUSIONS
  With identification of risk factors and modification of the surgical technique, the complication rate of biliary reconstruction of right lobe LDLT could be reduced. Repeated hepaticojejunostomy without preoperative PTBD is the preferred approach once a complication develops.
authors.affiliation: Centre for the Study of Liver Disease, Department of Surgery and Diagnostic Radiology, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China. hrmsfst@hkucc.hku.hk
authors.forename: Sheung-Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Chung-Mau
authors.initials: CM
authors.lastname: Lo
authors.forename: Chi-Leung
authors.initials: CL
authors.lastname: Liu
authors.forename: Wai-Kuen
authors.initials: WK
authors.lastname: Tso
authors.forename: John
authors.initials: J
authors.lastname: Wong
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D001652:Bile Ducts / Q000601:surgery; D001660:Biliary Tract Diseases / Q000209:etiology* / Q000628:therapy; D003251:Constriction, Pathologic; D006500:Hepatic Duct, Common / Q000473:pathology / Q000601:surgery; D006801:Humans; D007583:Jejunum / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D012307:Risk Factors