Relationship Between Bile Duct Reconstruction and Complications in Living Donor Liver Transplantation.
OBJECTIVE
In living donor liver transplantation (LDLT), the recipient bile duct is thin and short. Bile duct complications often occur in LDLT, with persistent long-term adverse effects. Recently, we began to perform microsurgical reconstruction of the bile duct. The purpose of this study was to investigate the relationship between bile duct reconstruction methods and complications in LDLT.


METHODS
From 1991 to 2014, we performed 161 LDLTs (pediatric:adult = 90:71; left lobe:right lobe = 95:66). In this study, we retrospectively investigated the initial bile duct complications in LDLT and performed univariate and multivariate analyses to identify the independent risk factors for complications.


RESULTS
The most frequent complication was biliary stricture (9.9%), followed by biliary leakage (6.8%). On univariate and multiple logistic regression analysis, the independent risk factors for biliary stricture were bile leakage (P = .0103) and recurrent cholangitis (P = .0077). However, there were no risk factors for biliary leakage on univariate analysis in our study. The reconstruction methods (hepaticojejunostomy or duct-to-duct anastomosis) and reconstruction technique (with or without microsurgery) were not risk factors for biliary stricture and leakage.


CONCLUSIONS
In this study, the most frequent complication of LDLT was biliary stricture. The independent risk factors for biliary stricture were biliary leakage and recurrent cholangitis. Duct-to-duct anastomosis and microsurgical reconstruction of the bile duct were not risk factors for biliary stricture and leakage.
Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan. Electronic address: msmsmiyagi@yahoo.co.jp.
S
S
Miyagi
Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan.
N
N
Kawagishi
Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan.
T
T
Kashiwadate
Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan.
A
A
Fujio
Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan.
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K
Tokodai
Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan.
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Y
Hara
Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan.
C
C
Nakanishi
Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan.
T
T
Kamei
Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan.
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N
Ohuchi
Division of Transplantation, Upper Digestive and Vascular Surgery, Tohoku University, Sendai, Japan.
S
S
Satomi
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000453:epidemiology; D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002761:Cholangitis / Q000453:epidemiology*; D003251:Constriction, Pathologic / Q000453:epidemiology; D005260:Female; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007582:Jejunostomy / Q000379:methods; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008866:Microsurgery / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult