Biliary Reconstruction Using High Biliary Radical Is Safe Option for Multiple Graft Bile Ducts in Right Lobe Living Donor Liver Transplantation

Abstract

Multiple small size donor bile ducts (BDs) are related to higher incidence of biliary complications (BCs) and biliary reconstruction for multiple BDs still remains a technical challenge during living donor liver transplantation (LDLT). Especially biliary reconstructions using high biliary radicals (right or left hepatic duct) on the recipient for multiple BDs are associated with very high probability of BCs secondary to devacularization and ischemia. Therefore, hepaticojejunostomy has been preferred in cases with multiple BDs which are not close each other although duct to duct anastomosis (DDA) has more physiological advantages. Herein, we analyzed clinical outcomes through retrospective reviews 227 patients receiving DDA for right lobe grafts LDLT from January 2013 to September 2018. 87 LDLT using grafts with multiple BDs have been performed and among them, 39 patients received DDA using high biliary radicals as recipient's BD using minimal hilar dissection, external biliary stents and mucosal eversion technique. We compared clinical outcomes with those in group using common hepatic duct as recipient's BD for multiple BD (CHD group). The incidence of biliary leakage and stricture were 10.3% and 12.8% and these results were not different to those in CHD group. Moreover, these results were comparable to those in group with single graft BD during the same periods. In conclusion, the choice high biliary radicals as the recipient's BD for multiple graft BDs was not associated with more BCs and could be safe option for biliary reconstruction with multiple BDs under our strategies.