title: Safety of duct-to-duct biliary reconstruction in right-lobe live-donor liver transplantation without biliary drainage.
abstract: BACKGROUND
  Duct-to-duct biliary reconstruction is frequently used in right-lobe live-donor liver transplantation (RLDLT), and routine biliary drainage has been recommended. The aim of the present study was to evaluate the safety and operative outcomes of duct-to-duct biliary reconstruction after RLDLT without biliary drainage.
  
  
  METHODS
  The study comprised 41 RLDLT recipients who had duct-to-duct biliary reconstruction. During donor and recipient operations, precautions were taken to preserve blood supply to the bile duct. Biliary anastomosis was performed with fine Prolene sutures without stents or drainage tubes. The operative outcomes were prospectively evaluated.
  
  
  RESULTS
  The median postoperative intensive care unit and hospital stay were 3 days (range, 1-47 days) and 19 days (range, 8-114 days), respectively. There was no hospital mortality. At a median follow-up of 13.3 months (range, 4.0-26.8 months), the graft and patient survival rates were 95% and 98%, respectively. Three (7%) patients had biliary leakage. These three patients and the other seven patients developed late biliary stricture. The overall biliary complication rate was 24%. On multivariate analysis, preoperative Model for End-Stage Liver Disease (MELD) score of greater than or equal to 35 was the risk factor associated with biliary complication (P =0.032; risk ratio, 4.58).
  
  
  CONCLUSIONS
  Duct-to-duct anastomosis without biliary drainage is safe in RLDLT. Patients with a high preoperative MELD score were associated with an increased incidence of biliary complications. Further studies are required to investigate the hemodynamic changes and modulation of blood flow of liver grafts in patients with chronic liver disease, which may significantly affect the incidence of biliary complications.
authors.affiliation: Centre for the Study of Liver Disease and Department of Surgery, University of Hong Kong, Pokfulam, Hong Kong, China. clliu@khucc.hku.hk
authors.forename: Chi-Leung
authors.initials: CL
authors.lastname: Liu
authors.forename: Chung-Mau
authors.initials: CM
authors.lastname: Lo
authors.forename: See-Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Sheung-Tat
authors.initials: ST
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000328:Adult; D001646:Bile / Q000378:metabolism; D001652:Bile Ducts / Q000378:metabolism / Q000601:surgery*; D002779:Cholestasis / Q000453:epidemiology / Q000378:metabolism / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome