title: Duct-to-duct biliary reconstruction in patients with primary sclerosing cholangitis undergoing liver transplantation.
abstract: BACKGROUND
  Reconstruction of biliary drainage after liver transplantation (LTx) in patients with primary sclerosing cholangitis (PSC) has been a matter of controversy. Over recent years, the traditional method of Roux-en-Y hepaticojejunostomy (RY) has been challenged by duct-to-duct (DD) biliary reconstruction.
  
  
  METHODS
  This study represents a retrospective review of biliary complications, patient and graft survival after LTx in PSC patients based on type of biliary reconstruction. Outcomes of DD reconstruction in this group of patients and non-PSC patients are compared.
  
  
  RESULTS
  A total of 53 primary LTx procedures were performed for PSC between August 2005 and July 2010. Seven patients were excluded because unexpected cholangiocarcinoma was found in the explants (n=3) or because they received partial livers (n=4). Biliary reconstruction was performed as DD in 18 patients and RY in 28 patients. There were no bile leaks. Anastomotic stricture occurred in two (11%) patients in the DD group and one (4%) in the RY group. Two (7%) patients in the RY group developed non-PSC intrahepatic strictures and one had recurrence of PSC. Rates of 1- and 3-year patient and graft survival in the RY and DD groups were 96.7% and 96.7%, and 100% and 94.5%, respectively. In a group of 34 randomly selected patients transplanted for a non-PSC diagnosis with DD reconstruction during the same period, the anastomotic stricture rate was 9% and 1- and 3-year patient and graft survival rates were 97.0% and 88.5%; differences were not significant.
  
  
  CONCLUSIONS
  Duct-to-duct biliary reconstruction at the time of LTx in selected PSC patients is both effective and safe, and shows outcomes comparable with those of RY reconstruction in these patients and those of DD reconstruction in non-PSC patients.
authors.affiliation: Department of Internal Medicine, Hepato-Pancreato-Biliary/Liver Transplant Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Jamak Modaresi
authors.initials: JM
authors.lastname: Esfeh
authors.forename: Bijan
authors.initials: B
authors.lastname: Eghtesad
authors.forename: Peter
authors.initials: P
authors.lastname: Hodgkinson
authors.forename: Teresa
authors.initials: T
authors.lastname: Diago
authors.forename: Masato
authors.initials: M
authors.lastname: Fujiki
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Cristiano
authors.initials: C
authors.lastname: Quintini
authors.forename: Federico
authors.initials: F
authors.lastname: Aucejo
authors.forename: Dympna
authors.initials: D
authors.lastname: Kelly
authors.forename: Charles
authors.initials: C
authors.lastname: Winans
authors.forename: David
authors.initials: D
authors.lastname: Vogt
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
authors.forename: Nizar
authors.initials: N
authors.lastname: Zein
authors.forename: John
authors.initials: J
authors.lastname: Fung
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D001649:Bile Duct Diseases / Q000209:etiology / Q000628:therapy; D002768:Choledochostomy / Q000009:adverse effects; D003251:Constriction, Pathologic; D006085:Graft Survival; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D009820:Ohio; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome