Systematic review and meta-analysis of studies of biliary reconstruction in adult living donor liver transplantation.

Abstract

The chance of biliary complication after living donor liver transplantation (LDLT) is considerable. The objective of this study was to investigate the impact of biliary reconstruction method on post-LDLT biliary complications. Data sources are from PubMed and Web of Science. A systematic search was conducted using the search term '[biliary complications] OR [biliary complication] OR [biliary stricture] OR [bile leak] AND [living donor liver transplantation]'. Cross-referencing was allowed so as to encompass more potentially relevant studies. All English papers on adult LDLT published between 1990 and 2014 were considered for review. Papers focusing on biliary reconstruction method in relation to post-LDLT biliary complications were included. The meta-analysis recruited six retrospective studies but no randomized trial or prospective study. The six studies covered 1286 patients with 260 cases (20.2%) of biliary anastomotic stricture (BAS) and 118 cases (9.2%) of biliary leakage (BL). For biliary reconstruction, 365 patients (28.4%) underwent hepaticojejunostomy (HJ) and 909 (70.7%) underwent duct-to-duct anastomosis (DDA), while 12 (0.9%) underwent both and were thus excluded from the analysis. A lower rate of BAS was found in patients with HJ compared with patients with DDA (Mantel-Haenszel odds ratio 0.448, 95% confidence interval 0.311-0.643; P = 0.000). Rates of BL were similar in the two groups (Mantel-Haenszel odds ratio 1.27, 95% confidence interval 0.821-1.966; P = 0.283). In the comparison of HJ and DDA in adult LDLT, the latter was found to be associated with a bigger chance of BAS but not BL.