Duct-to-duct biliary reconstruction in orthotopic liver transplantation for primary sclerosing cholangitis: a viable and safe alternative.
Roux-en-Y loop is considered the reconstruction method of choice in Orthotopic Liver Transplantation (OLT) for Primary Sclerosing Cholangitis (PSC). We have adopted an approach of duct-to-duct (D-D) reconstruction when recipient common bile duct is free of gross disease. Patients were divided into two groups: patients who underwent a Roux-en-Y choledochojejunostomy and patients who had a D-D anastomosis. Morbidity, mortality, disease recurrence and graft and patient survival were compared between the two groups and analyzed. Ninety-one patients had OLT for PSC. Sixty-three patients underwent a D-D biliary reconstruction, whereas 28 patients had a Roux-en-Y loop. Biliary leak complicated 8% from the D-D group, and 14% from the Roux-en-Y group (P = 0.08), whereas biliary strictures were identified in 10% vs. 7% patients from the D-D and Roux-en-Y group, respectively (P = 0.9). Actuarial 1, 3 and 10 year survival for D-D and Roux-en-Y group was (87%, 80% and 62%) and (82%, 73% and 73%), respectively (P = 0.7). The corresponding 1, 3 and 10 year graft survival was (72%, 58% and 42%) and (67%, 58% and 53%), respectively (P = 0.6). No difference was seen in disease recurrence rates. D-D biliary reconstruction in OLT for selected PSC patients remains our first option of reconstruction.
Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free Campus, University College London Medical School, London, UK.
Osama
O
Damrah
Dinesh
D
Sharma
Andrew
A
Burroughs
Nancy
N
Rolando
Bimbi
B
Fernando
Brian
B
Davidson
Keith
K
Rolles
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures; D015209:Cholangitis, Sclerosing / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome