The effect of internal stent to reduce duct complication in living donor liver transplantation

Abstract

Introduction: Living donor liver transplantation (LDLT) is widely used as a major treatment modality for end-stage liver disease, hepatocellular carcinoma, and acute hepatic failure. However, biliary complication is still considered to be a technical "Achilles' heel" of LDLT due to the high incidence, requiring long-term interventional treatment, and potential risk for potential graft failure. The purpose of this study was to evaluate the effectiveness of internal stent for duct-to-duct anastomosis in LDLT. Method: From December 2016 to October 2018, LDLT was performed in 91 patients in our center. Duct-to-duct anastomosis was performed in all LDLT patients and ductal anastomosis was performed by single surgeon. respectively. The internal stent was a silicone tube of various diameters considering the duct size. Ninety-one patients were divided into non-stent group and stent group according to presence or absence of internal stent. Result: In all patients with LDLT, biliary complications occurred in 22 (24.2%) patients and anastomosis site leakage occurred in 8 (8.8%) patients. Among 8 patients, four (4.4%) patients required interventional treatment. Anastomosis site leakage was higher in the non-stent group (n=5, 10.4%) than in the stent group (n=3, 7.0%), although there was no statistical difference (p=0.563). Biliary complications were also higher in the non-stent group (n=15, 31.3%) than in the stent group (n=7, 16.3%), although there was no statistical difference (p=0.096). In univariate analysis, the ischemic time was longer in the leakage group (p = 0.05), the operation time was longer in the biliary complications group (p = 0.01). Conclusion: Although there was no statistically significant difference due to small case number, when internal stent was inserted, biliary complications including anastomosis leakage were reduced compared to no insertion. Further large-scale analyses of clinical data are required to support this study.