Duct-to-duct biliary reconstruction in adult living-donor liver transplantation

Abstract

Background: Bile duct-to-duct reconstruction is now used in living-donor liver transplantation (LDLT) for adult patients.

Methods: The results of duct-to-duct reconstruction were retrospectively analyzed. The subjects were 81 adult patients who underwent LDLT at the University of Tokyo Hospital with a follow-up period of at least 1 year. The hilar plate of the recipient was dissected to at least the second-order branch of the bile ducts. Duct-to-duct anastomosis was performed with interrupted sutures, and an external stent tube was inserted from the orifice opposite the hilar plate.

Results: During the observation period (median, 664 days), biliary complications were observed in 26 cases (32%). The complications included bile juice leakage at the anastomosis or dissection plane of the graft in 12 patients, anastomotic stenosis in 10 patients, and tube trouble in 6 patients. Two patients had bile juice leakage followed by stenosis. Of the 26 patients, 21 required surgical revision.

Conclusions: The current technique did not reduce morbidity as expected. Further technical advancement and refinement are needed for better results.