title: Risk factors and prevention of biliary anastomotic complications in adult living donor liver transplantation.
abstract: OBJECTIVE
  To evaluate risk factors of biliary anastomotic complications (BACs) and outcomes according to type of biliary reconstruction.
  
  
  METHODS
  A total of 33 consecutive adult living donor liver transplantation (LDLT) were reviewed, 17 of which had undergone Duct-to-Duct anastomosis (D-D). The remaining 16 patients received Roux-en-Y anastomosis (R-Y). The perioperative factors, such as the type of graft and the number of graft bile ducts, were analyzed retrospectively.
  
  
  RESULTS
  The overall incidence of BACs was 39.4%. The incidence of BACs was significantly higher in the patients with than without neoadjuvant chemotherapy (71.4% vs 10%, P = 0.050). There was no significant difference in the incidence of biliary leakage in patients with D-D vs those with R-Y. The incidence of biliary strictures following the healing of biliary leakage was significantly higher in D-D (60%) than in R-Y (0%) (P = 0.026). However, the incidence of BACs related bacteremia was significantly higher in R-Y than in D-D (71.4% vs 0%, P = 0.008). In D-D, use of T-tube stent remarkably reduced the incidence of BACs, compared with straight tube stent (0% vs 50%, P = 0.049).
  
  
  CONCLUSIONS
  Our experience showed an increase of BACs related bacteremia in the patients with R-Y. Therefore, D-D might be a preferred biliary reconstruction. However, the surgical refinement of D-D should be required because of the high incidence of biliary strictures. Use of the T-tube stent might lead to a significant reduction of BACs in D-D.
authors: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori 1-757, Niigata 951-8510, Japan. sugarman@med.niigata-u.ac.jp
authors: Satoshi
authors: S
authors: Yamamoto
authors: Yoshinobu
authors: Y
authors: Sato
authors: Hiroshi
authors: H
authors: Oya
authors: Hideki
authors: H
authors: Nakatsuka
authors: Takashi
authors: T
authors: Kobayashi
authors: Yoshiaki
authors: Y
authors: Hara
authors: Takaoki
authors: T
authors: Watanabe
authors: Isao
authors: I
authors: Kurosaki
authors: Katsuyoshi
authors: K
authors: Hatakeyama
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods*; D016470:Bacteremia / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
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