Biliary reconstruction in right lobe living-donor liver transplantation: Comparison of different techniques in 321 recipients.
OBJECTIVE
To assess the incidence of biliary complications after right lobe living-donor liver transplantation (LDLT) in patients undergoing duct-to-duct choledochocholedochostomy or Roux-en-Y choledochojejunostomy reconstruction.


BACKGROUND
Biliary tract complications remain one of the most serious morbidities following liver transplantation. No large series has yet been carried out to compare the 2 techniques in LDLT. This study undertook a retrospective assessment of the relation between the method of biliary reconstruction used and the complications reported.


METHODS
Between February 1998 and June 2004, 321 patients received right lobe LDLT. Biliary reconstruction was achieved with Roux-en-Y choledochojejunostomy in 121 patients, duct-to-duct choledochocholedochostomy in 192 patients, and combined Roux-en-Y and duct-to-duct choledochocholedochostomy in 8 patients. The number of graft bile duct and anastomosis, mode of anastomosis, use of stent tube, and management of biliary complications were analyzed.


RESULTS
The overall incidence of biliary complications was 24.0%. Univariate analysis revealed that hepatic artery complications, cytomegalovirus infections, and blood type incompatibility were significant risk factors for biliary complications. The respective incidence of biliary leakage and stricture were 12.4% and 8.3% for Roux-en-Y, and 4.7% and 26.6% for duct-to-duct reconstruction. Duct-to-duct choledochocholedochostomy showed a significantly lower incidence of leakage and a higher incidence of stricture; however, 74.5% of the stricture was managed with endoscopic treatment.


CONCLUSIONS
The authors found an increase in the biliary stricture rate in the duct-to-duct choledochocholedochostomy group. Because of greater physiologic bilioenteric continuity, less incidence of leakage, and easy endoscopic access, duct-to-duct reconstruction represents a feasible technique in right lobe LDLT.
Organ Transplant Unit, Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan. mureo@kuhp.kyoto-u.ac.jp
Mureo
M
Kasahara
Hiroto
H
Egawa
Yasutsugu
Y
Takada
Fumitaka
F
Oike
Seisuke
S
Sakamoto
Tetsuya
T
Kiuchi
Syujiro
S
Yazumi
Toshiya
T
Shibata
Koichi
K
Tanaka
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000601:surgery; D001662:Biliary Tract Surgical Procedures; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D002768:Choledochostomy; D002780:Cholestasis, Intrahepatic / Q000601:surgery; D005260:Female; D006525:Hepatitis, Viral, Human / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012307:Risk Factors