Is Duct to Duct biliary Anastomosis the Rule in Orthotopic Liver Transplantation?

Abstract

Biliary complications after Liver Transplantation continue to be the major cause of morbidity in 11-25 % of patients. Biliary complications in patients who underwent orthotopic liver transplantation (OLT) at our institute between March 2007 and June 2010 were analyzed retrospectively. 32 patients underwent Deceased Donor Liver Transplantation (DDLT) and in 12 patients Living Donor Liver Transplantation (LDLT) was done. No patients were lost to follow up. Follow up ranged between 4 and 44 months. During the study period, 44 patients underwent orthotopic liver transplantation. Patients were divided into two groups: Biliary Complications group (BC) n05 and Non Biliary Complications group (NBC) n039. Biliary complications occurred in 15.9 % of patients. Bile leaks accounted for majority of biliary complications. Fifteen variables were analyzed as possible risk factors for biliary complications. Of these, split grafts, duct to duct biliary anastomosis and total blood loss were statistically significant (P<0.05) for biliary complications. Endoscopic treatment was successful in managing biliary complications in 75 % of patients. Biliary complications are the most common major complications in orthotopic liver transplantation. Significant risk factors are split liver grafts and duct to duct biliary anastomosis. Increased blood loss is a predictor for post operative biliary complications. These complications should be managed by endoscopic interventions. Surgery is indicated following failure of endoscopic interventions.

Management of post-cholecystectomy bile duct injuries without operative mortality at Jakarta tertiary hospital in Indonesia – A cross-sectional study

“…Transection of common hepatic duct or common bile duct can be repaired immediately through a tension-free end-to-end anastomosis with or without an internal stent, using a non-absorbable suture. End-to-end anastomosis with internal stent was associated with a significantly higher stricture rate than choledocho-choledochostomy [ 21 ].…”

“…Roux-en-Y hepaticojejunostomy (RYHJ) is recommended when there is a long tissue loss [ 21 , 22 ]. In BDI, especially in cases treated in early phase (within 45 days), inflammation and adhesion not only can cause slight inaccuracy of injury classification but also hinder the recognition of remnant healthy biliary tract which will be used in biliary-enteric anastomosis.…”

Long-term Outcome of Endoscopic and Percutaneous Transhepatic Approaches for Biliary Complications in Liver Transplant Recipients

“…However, our findings of increased intraoperative blood loss in patients developing biliary complications ( P < 0.001) has been reported in a few other studies. 25 , 26 A recent study on a large cohort of liver transplanted children did not see a correlation between intraoperative blood units transfused and the development of biliary complications, 27 suggesting adults might be more sensitive to intraoperative blood loss and development of such complications.…”

Prediction of biliary anastomotic stricture after deceased donor liver transplantation: the impact of platelet counts - a retrospective study

“…These results are compatible with the study from Selvalkular et al . who reported that increased intraoperative blood loss was a predictor for post‐transplant biliary complications including BAS after LT. The current options to increase platelet counts include platelet transfusion, thrombopoietin mimetic agents, thrombopoietin‐receptor agonists, splenectomy, and ligation of the splenic artery.…”