Risk factors and prevention of biliary anastomotic complications in adult living donor liver transplantation

• Published in: World journal of gastroenterology : WJG 2007-08, Vol.13 (31), p.4236-4241
• Main Authors: Yamamoto, Satoshi, Sato, Yoshinobu, Oya, Hiroshi, Nakatsuka, Hideki, Kobayashi, Takashi, Hara, Yoshiaki, Watanabe, Takaoki, Kurosaki, Isao, Hatakeyama, Katsuyoshi
• Format: Article
• Language: English
• Subjects: Adult; Anastomosis, Roux-en-Y - adverse effects; Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Bacteremia - etiology; Female; Humans; Incidence; Kaplan-Meier Estimate; Liver Transplantation - methods; Living Donors; Male; Middle Aged; Postoperative Complications - etiology; Rapid Communication; Retrospective Studies; Risk Factors; Stents - adverse effects; Treatment Outcome
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v13.i31.4236

To evaluate risk factors of biliary anastomotic complications (BACs) and outcomes according to type of biliary reconstruction. A total of 33 consecutive adult living donor liver transplantation (LDLT) were reviewed, 17 of which had undergone Duct-to-Duct anastomosis (D-D). The remaining 16 patients received Roux-en-Y anastomosis (R-Y). The perioperative factors, such as the type of graft and the number of graft bile ducts, were analyzed retrospectively. The overall incidence of BACs was 39.4%. The incidence of BACs was significantly higher in the patients with than without neoadjuvant chemotherapy (71.4% vs 10%, P = 0.050). There was no significant difference in the incidence of biliary leakage in patients with D-D vs those with R-Y. The incidence of biliary strictures following the healing of biliary leakage was significantly higher in D-D (60%) than in R-Y (0%) (P = 0.026). However, the incidence of BACs related bacteremia was significantly higher in R-Y than in D-D (71.4% vs 0%, P = 0.008). In D-D, use of T-tube stent remarkably reduced the incidence of BACs, compared with straight tube stent (0% vs 50%, P = 0.049). Our experience showed an increase of BACs related bacteremia in the patients with R-Y. Therefore, D-D might be a preferred biliary reconstruction. However, the surgical refinement of D-D should be required because of the high incidence of biliary strictures. Use of the T-tube stent might lead to a significant reduction of BACs in D-D.