Korean J Transplant.  2022 Nov;36(Supple 1):S303. 10.4285/ATW2022.F-4424.

Intraoperative cholangiography for precise localization of accurate biliary division and hilar plate transection in living donor liver transplantation

• Hung KC
• Wang CC
• Li WF
• Lin YC
• Lin CC
• Lin TS

• KMID: 2535530
• DOI: http://doi.org/10.4285/ATW2022.F-4424

Abstract

Background
Biliary complications have been the Achilles heel of living donor liver transplantation (LDLT). Regardless of tech-nique used, a patient with multiple ductal openings has a higher incidence of biliary complications than those with single duct. Precise investigation of the donors biliary anatomy and accurate division of the bile duct (BD) are of paramount importance. We aimed to evaluate our strategy of the donors BD division using IOC localization with a radiopaque tagging method.
Methods
Sixty-six LDLTs from October 2020 to August 2022 were retrospectively investigated. To determine the BD division site, the radiopaque material was tagged transversely on the proposed division site of the BD by holding sutures. From October 2020 to September 2021 (period I, n=30), we used two radiopaque rubber band (1 mm in diameter) as the radiopaque material and then (period II, n=36) a home-made metal hook (20 mm in length, 1.5 mm in diameter) was used. IOC via the cystic duct was checked to identify the relation between the radiopaque tag and the proposed division site of the BD. Careful sharp division of the duct and the residual hilar plate was made. During Period II, we modified the division strategy: the residual hilar plate was transected cranially with the direction of 10 o –15 o left deviation.
Results
During period I, six patients were type I with short common trunk (SCT) of the right BD in 22 LDLTs using right-lobe grafts. Four grafts (67%) had two BD openings, and two with one BD opening. During period II, seven patients were type I with SCT in 25 right-lobe LDLTs. One graft (14%) had two BD openings, and six with one BD opening.
Conclusions
Using IOC with the appropriate radiopaque tags to localizing the division site, we could obtain coalesce BD in right-lobe LDLT with SCT of the right BD.