title: Feasibility of using the cystic duct for biliary reconstruction in right-lobe living donor liver transplantation.
abstract: Duct-to-duct biliary reconstruction has been introduced in adult living donor liver transplantation (LDLT). In right-lobe grafts, however, the presence of two or three separated bile duct orifices is not rare and makes an alternative approach for reconstruction necessary. We used the cystic duct for one of the anastomoses in biliary reconstruction for 5 right-lobe living donor liver transplants with two separated ducts. Before the anastomosis, the inside lumen of the cystic duct was straightened with a metal probe. Two external drainage tubes were placed in all recipients, and posttransplant cholangiography through the tubes approximately one month after transplantation showed no leakage or stricture at any of the anastomotic sites. The drainage tubes were removed between 17 and 37 weeks after transplantation. All of the patients except one who died of chronic rejection have been doing well without any late biliary complications during follow-up periods ranging from 10 to 28 months after transplantation. In conclusion, our results indicate that biliary reconstruction using the cystic duct is feasible and safe for living donor liver transplantation and that external drainage tubes may be effective for prevention of complications.
authors.affiliation: Department of Transplant and Pediatric Surgery, Kumamoto University, Kumamoto, Japan. aso@k4.dion.ne.jp
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Asonuma
authors.forename: Hideaki
authors.initials: H
authors.lastname: Okajima
authors.forename: Mikako
authors.initials: M
authors.lastname: Ueno
authors.forename: Takayuki
authors.initials: T
authors.lastname: Takeichi
authors.forename: Manuel E
authors.initials: ME
authors.lastname: Zeledon Ramirez
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Inomata
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000002:abnormalities / Q000601:surgery*; D015331:Cohort Studies; D003549:Cystic Duct / Q000637:transplantation*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome