title: Duct-to-Duct Biliary Anastomosis Yields Similar Outcomes to Roux-en-Y Hepaticojejunostomy in Liver Transplantation for Primary Sclerosing Cholangitis.
abstract: BACKGROUND
  While Roux-en-Y hepaticojejunostomy (RYH) is the common anastomotic technique for liver transplantation (LT) in patients with primary sclerosing cholangitis (PSC), duct-to-duct (DD) reconstruction may be used if the recipient common bile duct is normal. There are conflicting observational data on the rate of success of DD reconstruction versus RYH, in PSC.
  
  
  OBJECTIVE
  The aim of this study was to assess the safety and efficacy of DD anastomosis, compared to RYH reconstruction, among adults transplanted for PSC.
  
  
  METHODS
  All adult patients, who underwent primary LT for PSC between 1990 and 2012, were evaluated, according to type of biliary reconstruction. Recipient and graft survival, postoperative medical and surgical complications, and postoperative resource utilization rates were compared between the two groups.
  
  
  RESULTS
  Totally, 73 patients fulfilled the inclusion criteria. Of them, 58 had RYH and 15 had DD reconstruction. A total of 53 subjects (73%) were male, with the mean age ± standard deviation at LT of 43.3 ± 14.4 years. Rates of recipient mortality, graft failure, biliary complications, acute cellular rejection, and reoperation were similar in both groups. Postoperative cholangiography was used more frequently in patients with DD reconstruction (33.3% vs. 8.6%, P = 0.026).
  
  
  CONCLUSIONS
  In selected recipients with PSC, DD reconstruction is a safe and efficacious technique, with long-term clinical outcomes comparable to RYH.
authors.affiliation: Multi Organ Transplant Unit, Departments of Medicine and General Surgery, University of Western Ontario, London, Canada ; Department of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Bandar
authors.initials: B
authors.lastname: Al-Judaibi
authors.affiliation: Multi Organ Transplant Unit, Departments of Medicine and General Surgery, University of Western Ontario, London, Canada.
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernandez Alejandro
authors.affiliation: Multi Organ Transplant Unit, Departments of Medicine and General Surgery, University of Western Ontario, London, Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Uhanova
authors.affiliation: Multi Organ Transplant Unit, Departments of Medicine and General Surgery, University of Western Ontario, London, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Marotta
authors.affiliation: Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Mosli
authors.affiliation: Multi Organ Transplant Unit, Departments of Medicine and General Surgery, University of Western Ontario, London, Canada.
authors.forename: Natasha
authors.initials: N
authors.lastname: Chandok
keywords: Liver Transplantation; Primary Sclerosing Cholangitis; Roux-en-Y Anastomosis