title: Early and long-term results of routine microsurgical biliary reconstruction in living donor liver transplantation.
abstract: We describe our early and long-term experience with routine biliary reconstruction via a microsurgical technique in living donor liver transplantation (LDLT). One hundred seventy-seven grafts (including 3 dual grafts) were primarily transplanted into 174 recipients. The minimum follow-up was 44 months. Biliary reconstructions were based on biliary anatomical variations in graft and recipient ducts. The recipient demographics, graft characteristics, types of biliary reconstruction, biliary complications (BCs), and outcomes were evaluated. There were 130 right lobe grafts and 47 left lobe grafts. There were single ducts in 71.8%, 2 ducts in 26.0%, and 3 ducts in 2.3% of the grafts. The complications were not significantly related to the size and number of ducts, the discrepancy between recipient and donor ducts, the recipient age, the ischemia time, or the type of graft. The overall BC rate was 9.6%. The majority of the complications occurred within the first year, and only 1 patient developed a stricture at 20 months. No new complications were noted after 2 years. When the learning-curve phase of the first 15 cases was excluded, the overall BC rate was 6.79%, and the rate of complications requiring interventions was 2.5%. In conclusion, the routine use of microsurgical biliary reconstruction decreases the number of early and long-term anastomotic BCs in LDLT.
authors.affiliation: Liver Transplantation Program, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Tsan-Shiun
authors.initials: TS
authors.lastname: Lin
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Allan M
authors.initials: AM
authors.lastname: Concejero
authors.forename: Anthony Q
authors.initials: AQ
authors.lastname: Yap
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Lin
authors.forename: Chun-Yi
authors.initials: CY
authors.lastname: Liu
authors.forename: Yuan-Cheng
authors.initials: YC
authors.lastname: Chiang
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Shih-Ho
authors.initials: SH
authors.lastname: Wang
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.forename: Chee-Chien
authors.initials: CC
authors.lastname: Yong
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007223:Infant; D059032:Learning Curve; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult