Efficacy and superiority between ERCP and PTBD as first line intervention of biliary complication after liver transplantation

Abstract

Introduction: Biliary complication (BC) is still regarded the Achilles' heel of a living donor liver transplantation (LDLT). This study aims to evaluate the long-term outcomes of the ductto-duct (DD) biliary reconstruction using 7-0 suture and to identify the risk factors of BCs after LDLTs. Method: Data of 140 LDLT, between 2006 and 2015, were analyzed. All biliary reconstructions were performed as DD anastomoses using 7-0 suture, 102 for the right lobe, 20 for the left lobe, and 18 for right posterior sector grafts. BC was defined as a bile leakage (BL) or a biliary stricture (BS) and the median follow-up time after LDLT was 65 months. Result: Nineteen recipients (13.5%) developed BC (8 BL and 16 BS) after LDLT. The survival rates between recipients with and without BCs were 83% and 86.7 %, respectively (P = .882). In univariate analyses, the risk factors for BC were small diameter of the graft's bile duct, long warm-ischemic time, small graft-to-recipient weight ratio, and no use of external biliary stent (EBS). The graft's bile duct diameter 3 mm and no use of EBS were determined as independent risk factors (hazard ratios of 9.737 and 7.683, respectively) in multivariate analyses. The 116 recipients with EBS had no BL, 11 had BSs (9%), while 24 without EBS had 8 BL (33 %) and 5 BS (21 %). After a propensity score match between the recipients with and without EBS, the EBS group (24) developed only one BS (4%). Conclusion: DD anastomosis using 7-0 suture combined with EBS could provide favorable long-term outcomes after LDLT, which should thus be considered the surgical technique of choice for LDLTs.