RESULTS OF DUCT-TO-DUCT BILIARY ANASTOMOSIS IN PARTIAL LIVER GRAFT TRANSPLANTATION

Abstract

P560 Aims: The efficacy of duct-to-duct biliary reconstruction in transplantation of partial liver grafts obtained from living donors (LD) and split livers from cadaveric donors (SLCD) was evaluated. Patients and methods: From july 2000 to December 2003, 71 liver transplantations (LT) with partial grafts from living donors (n=59) and cadaveric left split livers (n=12) were performed in 61 adult and 10 pediatric recipients by using 49 right lobes (all from LD), 18 left lobes (from 11 SLCD and 7 LD), and 4 left lateral segments (from 3 LD and 1 SLCD). In all cases, duct-to-duct biliary reconstruction was done. Six patients (8.4%) died during the first 3 months after LT and were excluded from the study. In the remaining 65 patients, biliary reconstruction was achieved by interrupted 6/0 resorbable sutures between the donor right bile duct and the recipient common bile duct (n=31), the two joined posterior and anterior sectorial right donor bile ducts and the recipient common bile duct (n=9) and the donor left bile duct and the recipient common bile duct (n=22). In 9 cases, a double duct-to-duct right separated biliary (from posterior and anterior sectors) anastomosis was done. In all biliary anastomosis but one, an external biliary stent was pushed upward into the anastomosis through the wall of of the recipient common bile duct. Results: Fourteen biliary complications occured in 13 patients (20%), including 6 bile leaks (9.2%) from the anastomotic site (4 cases) and the cut surface (2 cases) and 8 anastomotic stenosis (12.3%). Although the difference was not statistically significant, biliary complicatons were more common in right than in left liver graft transplantations (23.9% versus 10.5%) and in living donor grafts than in split grafts (23.2% versus 0). The number of biliary anastomoses (one or two) performed per graft did not influenced the incidence of biliary complications (21.8% versus 22.2%). The incidence of hepatic artery thrombosis was nil. Anastomotic bile leakages resolved after surgical revision in 2 cases, with endoscopic stenting in 1 case and external drainage in the last case. The 2 bile leaks from the cut surface spontaneously resolved after external drainage. Successful outcome of anastomotic biliary stenosis occured following endoscopic manœuvrers in 7 cases and surgical treatment in 1 case. After a mean follow-up of 18.3 months (range : 3 – 45), patient and graft survivals were 87.3% and 85.3% respectively. Conclusion: Whatever the type of partial liver grafts, duct-to-duct biliary reconstruction with an external stent is feasible in almost all cases and represents a safe and efficient option especially in left grafts from split livers.