Routine microsurgical biliary reconstruction decreases early anastomotic complications in living donor liver transplantation.
Biliary reconstruction using a microsurgical technique in living donor liver transplantation was routinely performed on 88 grafts primarily transplanted into 85 patients. All procedures were performed under a microscope by a single microsurgeon. Except for biliary atresia and Alagille syndrome, duct-to-duct reconstruction was performed. Stents were not used. The outcomes with microsurgical biliary reconstruction (MB) were compared with the outcomes of a cohort of 86 grafts in 85 patients that underwent conventional biliary reconstruction (CB). The identification of complications included only up to 12 months of follow-up for each recipient in both groups. The average graft duct sizes were 2.8 mm for MB and 3.4 mm for CB. Most complications occurred in the first 15 cases with MB, and these cases were considered to constitute the learning curve phase. The MB complication rate was 46.7% in the first 15 cases, 20.0% in the next 15 cases, and 5.4% in the last 55 cases. When the learning curve phase was excluded, the overall complication rate over time with MB (8.9%) was significantly lower than that with CB (21.9%). CB increased the risk of biliary complications by 2.5 times (relative risk: 2.5; attributable risk: 128; odds ratio: 2.9). In conclusion, routine MB is a technical innovation that leads to decreased early anastomotic complications in living donor liver transplantation.
Lin
Tsan-Shiun
TS
Liver Transplantation Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Concejero
Allan M
AM
Chen
Chao-Long
CL
Chiang
Yuan-Cheng
YC
Wang
Chih-Chi
CC
Wang
Shih-Ho
SH
Liu
Yueh-Wei
YW
Yang
Chin-Hsiang
CH
Yong
Chee-Chien
CC
Jawan
Bruno
B
Cheng
Yu-Fan
YF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001660:Biliary Tract Diseases / Q000209:etiology / Q000517:prevention & control*; D001662:Biliary Tract Surgical Procedures; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult