Journal List > J Korean Soc Transplant > v.30(1) > 1034506

J Korean Soc Transplant. 2016 Mar;30(1):6-12. Korean.
Published online March 31, 2016.  https://doi.org/10.4285/jkstn.2016.30.1.6
Copyright © 2016 The Korean Society for Transplantation
Single Center Experience of Biliary Reconstruction in Living Donor Liver Transplantation: Duct-to-Duct Anastomosis
Jin Hoon Nam, M.D., Seok Jeong Yang, M.D., Jae Geun Lee, M.D., Dong Jin Joo, M.D., Dai Hoon Han, M.D., Gi Hong Choi, M.D. and Jin Sub Choi, M.D.
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Jin Sub Choi. Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: 82-2-2228-2122, Fax: 82-2-2313-8289, Email: choi5491@yuhs.ac
Received September 22, 2015; Revised January 12, 2016; Accepted February 04, 2016.

Abstract

Background

Duct-to-duct anastomosis is the most common biliary reconstruction method in living donor liver transplantation. However, biliary complications can frequently occur. The objective of this study was to examine biliary complications and related risk factors of patients with living donor liver transplantation during the last 12 years in our institution.

Methods

Surgical outcomes of 252 consecutive patients with duct-to-duct anastomosis for biliary reconstruction in living donor liver transplantation between December 2000 and July 2012 were analyzed retrospectively.

Results

Among the 252 patients, there were 65 cases (25.8%) of biliary complications. Before 2010, the incidence of biliary complications was 30.4% (56 of 184 cases). After 2011, the incidence was significantly (P<0.05) decreased to 13.2% (nine out of 68 cases). The complication rate of anastomosis of two separated bile ducts of graft to recipient two separated bile ducts using cystic duct and common bile duct of recipient was 50% (10 out of 20), which was relatively higher compared to that of single to single duct anastomosis (47 out of 191, 24.6%) or multiple duct to single duct anastomosis (eight out of 41, 19.5%).

Conclusions

Duct to duct anastomosis between two separated bile ducts of a graft to two separated bile ducts of a recipient, the most common biliary reconstruction method, was associated with higher rate of biliary complications. Complications related to biliary reconstruction of living donor liver transplantation was gradually decreased. Standardization of bile duct anastomosis might lead to sequential reduction of biliary complications in living donor liver transplantations.

Keywords: Liver transplantation; Bile ducts; Anastomosis; Postoperative complications

Figures


Fig. 1
Annual Incidence of living donor liver transplantation.
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Fig. 2
Annual biliary complication after living donor liver transplantation.
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Tables


Table 1
Clinical feature of the patients with duct-to-duct anastomosis
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Table 2
Comparison of biliary complication by operation period
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Table 3
Donor factors associated with biliary complications
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Table 4
Recipient factors associated with biliary complications
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Table 5
Biliary complication according to the type of anastomosis
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