Long-Term Follow-Up Study of Biliary Reconstructions and Complications After Adult Living Donor Liver Transplantation.

Abstract

The aim of this study was to analyze the feasibility of duct-to-duct biliary reconstruction (hepaticohepaticostomy) with a T-tube stent (HH-T) after adult living donor liver transplantation (LDLT) based on long-term follow-up. We retrospectively evaluated 89 primary adult LDLTs who had survived 1 month from March 1999 to March 2012.There were 46 men and 43 women. Overall median age of the recipients was 54 years (range, 17-70 years). Indications for LDLT were hepatocellular carcinoma(n = 28), fulminant hepatic failure (n = 15), cholestatic liver disease (including primary biliary cirrhosis and primary sclerosing cholangitis; n=15), viral hepatitis (n = 10), metabolic liver disease(n = 7), Budd-Chiari syndrome (n = 3), and other etiologies(n = 11). We compared the incidence of bile leaks and biliary strictures (BS) in 3 groups of patients:Roux-en-Y hepaticojejunostomy (HJ; n = 26); duct-to-duct hepaticohepaticostomy with external stents except a T-tube (HH; n = 35); and HH-T (n = 28). Median follow-up was longer among the HH (81 months) than the other groups (63 months in HJ and 48 months in HH-T). Bile leaks developed in 7 of the HJ cases (27%); 6 of the HH cases (17%); and 2 of the HH-T cases (6%; P = .13). All cases with bile leaks (n = 15) were treated using continuous drainage, 12 of them (80%) successfully. BS developed in 4 HJ cases (22%); 8 HH cases (23%), and 4 HH-T cases (14%; P = .57). Intervention for BS (n = 20) was successful in 10 cases (50%) via an endoscopic approach and 6 cases (30%) via a percutaneous transhepatic approach. Operative management for BS was required in 4 cases (20%). Biliary reconstruction using HH-T may be effective to prevent bile leaks after LDLT. However, HH-T may not decrease the incidence of BS after adult LDLT.