Korean J Transplant.  2022 Nov;36(Supple 1):S83. 10.4285/ATW2022.F-2008.

Outcomes and biliary complications of staged biliary reconstruction in living donor liver transplantation: a propensity score matched analysis

• Hou TY
• Wang CC
• Chen CL
• Lin CC
• Wang SH
• Yong CC
• Lin TS
• Lee WF
• Yeh CH

• KMID: 2535599
• DOI: http://doi.org/10.4285/ATW2022.F-2008

Abstract

Background
Uncontrolled massive bleeding and bowel edema are critical issues during performing liver transplantation. In encountering these circumstances, temporal intra-abdominal packing with staged biliary reconstruction (SBR) had been mentioned as comparable results in deceased donor liver transplantation. However, data in living donor liver transplantation (LDLT) are scarce. Therefore, we aim to analyze the survival and biliary complications of SBR in LDLT.
Methods
From January 1, 2009, to January 31, 2020, 1,269 patients underwent LDLT at Kaohsiung Chang Gung Memorial Hospital. Among them, 55 Patients receiving LDLT with SBR were included in SBR group. One-to-two propensity score matching was performed by age, gender, blood loss, model for end-stage liver disease score, Child-Pugh score, and operation period. One-hun-dred-ten patients receiving one-stage biliary reconstruction (OSBR) LDLT are as OSBR group. Primary outcomes were graft and patient survival. Secondary outcomes were postoperative biliary complications.
Results
The mean follow-up was 63 months. Mean blood loss was 8,987 mL in SBR group and 8,582 mL in OSBR group. Pa-tients in SBR Group had more abdominal operation history (49.1% vs. 25.5%, P=0.002), longer an hepatic time (86 vs. 67 min-utes, P=0.007), and more intraoperative blood transfusion (32 vs. 19 units of leukocyte-poor red blood cells, P=0.010) compar-ing to OSBR group. Roux-en-Y hepaticojejunostomy was performed in 74.55% (SBR group) and 3.64% (OSBR group) (P<0.001). Patients receiving SBR-LDLT had higher incidence of sepsis (69.01% vs. 43.64 %, P=0.002), intra-abdominal infection (60.0% vs. 30.9%, P<0.001) and antibiotic duration (35 vs. 18 days, P<0.001) compared to OSBR-LDLT. Biliary complication rates (30.9% vs.21.8%, P=0.203) and 1- and 5-year survival rates for graft (87.27%, 74.60% vs. 83.64%, 72.71%; P=0.978) and for patient (89.09%, 78.44% vs. 84.55%, 73.70%; P=0.752) were comparable between two groups.
Conclusions
Despite a higher postoperation complication rate, the long-term survival and biliary outcome of SBR group are comparable. SBR is a life-saving procedure for patients in complex critical LDLT.