Korean J Transplant.  2022 Nov;36(Supple 1):S307. 10.4285/ATW2022.F-4483.

Is it acceptable to perform duct to duct anastomosis during living donor liver transplantation in patients with hepatocellular carcinoma treated with external beam radiotherapy before?

• Na BG
• Jung DH
• Park Gc
• Hwang S
• Kim KH
• Ahn CS
• Moon DB
• Ha TY
• Yoon YI
• Lee SG

• KMID: 2535534
• DOI: http://doi.org/10.4285/ATW2022.F-4483

Abstract

Background
External beam radiotherapy (EBRT) has been proven to provide acceptable oncologic outcomes in the selected patients with hepatocellular carcinoma (HCC), followed by adult living donor liver transplantation (LDLT). The study aims to evaluate the biliary stricture after duct-to-duct anastomosis during LDLT in patients with HCC previously treated with EBRT.
Methods
We retrospectively enrolled 51 patients with HCC treated with EBRT who underwent duct-to-duct anastomosis during LDLT using a single right graft between January 2019 and December 2020. Perihilar EBRT case was defined as when right and left hepatic ducts, common hepatic duct, and common bile duct were close to or included in the planning tumor volume (PTV) for EBRT. We identified the risk factors for biliary stricture by analyzing the LDLT and EBRT factors.
Results
During a median follow-up period of 24.6 months (range, 138 months), 17 patients (33.3%) presented biliary stricture after LDLT. In a comparative analysis between biliary stricture and no stricture groups, the patients with perihilar EBRT in the biliary stricture group were significantly more than those in the no stricture group (50.0% vs. 15.2%, P=0.016). In univariate and multivariate analyses, intraoperative portal vein stent insertion (hazard ratio [HR], 7.81; 95% confidence interval [CI], 1.5339.99; P=0.014) and perihilar EBRT (HR, 5.34; 95% CI, 1.2223.12; P=0.026) were identified as significant risk factors for biliary stricture.
Conclusions
Duct-to-duct anastomosis in LDLT can be acceptable if PTV does not contain the perihilar area. Otherwise, hepa-ticojejunostomy can be recommended to prevent biliary stricture instead of duct-to-duct anastomosis.