BILIARY COMPLICATIONS IN LIVING DONOR LIVER TRANSPLANTATION

Abstract

O446 Aims: Biliary complications remain one of the most serious problems after living donor liver transplantation (LDLT). Hepaticojejunostomy (HJ stomy) has been a standard procedure for biliary recontruction. However, recently, duct-to-duct (DD) anastomosis is used more widely, because DD anastomosis has more physiologic bilioenteric continuity. We performed this study to evaluate safety of various biliary reconstruction for LDLT. Methods: Between January 1999 and December 2002, 147 recipients, > 1 year postoperatively, were enrolled. HJ stomy was performed in 85 cases (57.8%) and DD anastomosis in 62 cases (42.2%). In DD anastomosis, a T-tube was inserted via CBD in 33 cases(53.2%), a internal stent tube was pushed upward in the anastomosis throughout CBD in 7 cases (11.3%), and no drainage tube was used in 22 cases (5.5%). Results: Among 147 cases, 30 biliary complications developed (20.4%). In HJ stomy, the incidence of complication was 8.2% (7/85). The complications in HJ stomy consisted of 3 cases of bile leak, 4 cases of biliary stricture. In DD anastomosis, the incidence of complication was 37.1% (23/62). The complication rate in cases using a internal stent was 71.4% (5/7). Complications consisted of 4 cases of bile leak and one case of biliary stricture. The complication rate in cases using a T-tube was 33.3% (11/33). Complications consisted of 6 cases associated with tube removal, 5 cases of biliary stricture. The complication rate in cases without biliary drainage tube was 31.8% (7/22). Complications consisted of one accidental ligation of right posterior duct and 6 cases of biliary stricture. The complication rate was lower in HJ stomy than in DD anastomosis (p<0.05). Surgical correction of complications was more frequently needed in complications of HJ stomy than in that of DD anastomosis. Reoperation rate was 28.5% (3/7) in complications of HJ stomy. Conversion rate of DD anstomosis to HJ stomy was 8.7% (2/23). In cases of DD anastomosis without a stent, all complications were corrected by radiologic intervention. However there was no statistical significance Conclusions: In LDLT, the complication rate of various biliary reconstructions was 20.4%. The complication rate of HJ stomy was lower than that of DD anstomosis. For further evaluation, a controlled radomized study was needed.