Introduction: Multiple small sized graft bile ducts (BDs) are related to higher incidence of biliary complications (BCs) and biliary reconstruction for multiple BDs still remains a technical challenge during living donor liver transplantation (LDLT). Especially, biliary reconstruction using high biliary radicals (right or left hepatic duct) of recipients for multiple BDs has very high probability of BCs secondary to devacularization and ischemia. Therefore, hepaticojejunostomy has been performed in cases with multiple BDs which are not close to each other although duct to duct anastomosis (DDA) has more physiological advantages.
Methods: Herein, we analyzed clinical outcomes through retrospective reviews 227 patients receiving DDA for right lobe grafts LDLT from January 2013 to September 2018. The principle of biliary reconstruction for multiple graft BDs is performing DDA as much as possible. 87 LDLT using grafts with multiple BDs have been performed and 39 patients received DDA using high biliary radicals among them with minimal hilar dissection, external biliary stents and mucosal eversion technique. We compared clinical outcomes between these 39 patients and those receiving DDA using common hepatic duct of recipients for multiple BDs (CHD group).
Results: The incidence of biliary leakage and stricture were 10.3% and 12.8% and these results were not different to those in CHD group. Neither overall patient survival nor graft survival differed significantly between the two groups . Moreover, these results were comparable to those in groups using graft with single BD during the same periods.
Conclusions: The choice of high biliary radicals as the recipient BD for multiple graft BDs was not associated with higher incidence of BCs. Therefore, this could be safe option for biliary reconstruction with multiple graft BDs during LDLT and seems to reduce the chance of hepaticojejunostomy.