Risk factor analysis and procedural modifications for biliary stricture after adult living donor liver transplantation

M. Shinoda, M. Tanabe, S. Kawachi, O. Itano, H. Obara, T. Hibi, K. Matsubara, N. Shimojima, Y. Fuchimoto, K. Hoshino, G. Wakabayashi, M. Shimazu, Y. Morikawa, M. Kitajima, Y. Kitagawa

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Abstract

Background: We undertook a retrospective assessment of risk factors for biliary stricture after adult living donor liver transplantation (LDLT) and evaluated risk reduction following the implementation of modified surgical procedures. Methods: Between June 1997 and December 2009, 85 adult patients underwent LDLT. Up to September 2006, we performed duct-to-duct hepaticocholedochostomy (D-D) in 38 patients and Roux-en-Y hepaticojejunostomy (R-Y) in 24 patients. Risk factors for biliary stricture were analyzed for these patients. We then performed D-D in 23 patients using modified procedures and assessed the resultant outcomes. Results: D-D was a significant risk factor in the 62 patients who underwent LDLT before September 2006. Despite this result, we decided to employ only D-D for subsequent cases. Since the presence of multiple graft bile duct orifices was a significant risk factor in the 38 patients who underwent D-D, we used modified procedures after October 2006 to address grafts with multiple bile duct orifices. The procedures included:1) inserting a biliary tube from the common bile duct;2) placing the tip of tube beyond the anastomosis;3) inserting the tubes in all the anastomoses if multiple; and 4) maintaining the tube for 6 months postoperatively. The incidence of biliary stricture after D-D was significantly less frequent with the use of these procedures (before:36%; after:13%). Conclusions: In our early experience, D-D was a significant risk factor for biliary stricture after adult LDLT. Although we are now employing only D-D, our procedural modifications seem promising for preventing biliary stricture after D-D.

Original languageEnglish
Pages (from-to)267-273
Number of pages7
JournalEuropean Surgery - Acta Chirurgica Austriaca
Volume44
Issue number4
DOIs
Publication statusPublished - 2012 Aug

Keywords

  • Biliary stricture
  • Biliary tube
  • Living donor liver transplantation
  • Risk factor

ASJC Scopus subject areas

  • Surgery

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    Shinoda, M., Tanabe, M., Kawachi, S., Itano, O., Obara, H., Hibi, T., Matsubara, K., Shimojima, N., Fuchimoto, Y., Hoshino, K., Wakabayashi, G., Shimazu, M., Morikawa, Y., Kitajima, M., & Kitagawa, Y. (2012). Risk factor analysis and procedural modifications for biliary stricture after adult living donor liver transplantation. European Surgery - Acta Chirurgica Austriaca, 44(4), 267-273. https://doi.org/10.1007/s10353-012-0082-y