Korean J Transplant.  2022 Nov;36(Supple 1):S287. 10.4285/ATW2022.F-4273.

Biliary reconstruction for multiple graft bile ducts does not impact posttransplant outcome compared with one graft bile duct during living donor liver transplantation

• Kim J
• Choi DL
• Han JR
• Han YS

• KMID: 2535514
• DOI: http://doi.org/10.4285/ATW2022.F-4273

Abstract

Background
Multiple graft bile ducts (BDs) are related to higher incidence of biliary complications (BCs), and biliary reconstruc-tion for multiple BDs still remain a technical challenge during living donor liver transplantation (LDLT). Especially, biliary recon-struction using high biliary radicals of recipients for multiple BDs has very high probability of BCs secondary to devascularization and ischemia.
Methods
Herein, we analyzed clinical outcomes through retrospective reviews 281 patients receiving duct to duct anastomosis (DDA) for right lobe grafts LDLT from January 2013 to September 2019. A total of 104 LDLT using grafts with multiple BDs have been performed under our strategy. In cases with two close ducts or the two orifices were located in the same hilar plate, we have recently performed dunking with mucosal eversion technique instead of ductoplasty. In the cases of two orifices far located, we tried to perform two separate DDAs using high biliary radicals of the recipient with minimal hilar dissection, external biliary stents and mucosal eversion technique to reduce BCs.
Results
Among multiple BDs group, 20 underwent unification ductoplasty, 45 were treated using dunking with mucosal eversion technique, and 39 patients underwent two DDAs separately using high biliary radicals (HBR group). The incidence of biliary leak-age and stricture were 11.5% and 10.6%, respectively, in multiple BDs group and these outcomes were not different to those in one BD group. Neither overall patient survival nor graft survival differed significantly between the two groups. In subgroup anal-ysis, we compared clinical outcomes between HBR group and one BD group and the incidence of biliary complications in HBR group was 10.3%, which was comparable to that in one BD group.
Conclusions
LDLT using multiple graft BDs could be a safely without negative impacts on posttransplant outcomes. Furthermore, biliary reconstruction using high biliary radicals could be a safe option for multiple graft BDs during LDLT.