Single-center experience and long-term outcomes of duct-to-duct biliary reconstruction in infantile living donor liver transplantation

Yamamoto, Haruyasu; Hayashida, Shintaro; Asonuma, Katsuhiro; Honda, Masaki; Suda, Hiroko; Muroya, Takahiro; Ohya, Yuki; Lee, Kwang Jong; Takeichi, Takayuki; Inomata, Yukihiro

doi:10.1002/lt.23819

Cited by 12 publications

(23 citation statements)

References 15 publications

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“…The incidence of biliary stricture after pediatric LT ranges from 4.5% to 14.9% and from 8.9% to 16.7% in smaller infants, which is comparable to the incidence of 5.4% reported in the present series. Similarly, reported biliary leak ranges from 0% to 21.4% in pediatric LT, and in our study, the incidence of biliary leak in smaller infants was 2.7%. Some studies have suggested that the incidence of biliary complications in smaller infants is similar to that of older children .…”

Section: Discussionsupporting

confidence: 85%

Outcomes of Liver Transplantation in Small Infants

et al. 2019

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Liver transplantation (LT) for small infants remains challenging because of the demands related to graft selection, surgical technique, and perioperative management. The aim of this study was to evaluate the short‐term and longterm outcomes of LT regarding vascular/biliary complications, renal function, growth, and patient/graft survival in infants ≤3 months compared with those of an age between >3 and 6 months at a single transplant center. A total of 64 infants ≤6 months underwent LT and were divided into 2 groups according to age at LT: those of age ≤3 months (range, 6‐118 days; XS group, n = 37) and those of age >3 to ≤6 months (range, 124‐179 days; S group, n = 27) between 1989 and 2014. Acute liver failure was the main indication for LT in the XS group (n = 31, 84%) versus S (n = 7, 26%). The overall incidence of hepatic artery thrombosis and portal vein thrombosis/stricture were 5.4% and 10.8% in the XS group and 7.4% and 11.1% in the S group, respectively (not significant). The overall incidence of biliary stricture and leakage were 5.4% and 2.7% in the XS group and 3.7% and 3.7% in the S group, respectively (not significant). There was no significant difference between the 2 groups in terms of renal function. No significant difference was found between the 2 groups for each year after LT in terms of height and weight z score. The 1‐, 5‐, and 10‐year patient survival rates were 70.3%, 70.3%, and 70.3% in the XS group compared with 92.6%, 88.9%, and 88.9% in the S group, respectively (not significant). In conclusion, LT for smaller infants has acceptable outcomes despite the challenges of surgical technique, including vascular reconstruction and graft preparation, and perioperative management.

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Section: Discussionsupporting

confidence: 85%

Outcomes of Liver Transplantation in Small Infants

et al. 2019

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“…However, biliary complications caused by these reasons do not commonly occur because Roux‐en‐Y hepaticojejunostomy remains the standard treatment of choice for pediatric LDLT, which may be less susceptible to bile duct deformity. A recent study by Yamamoto et al . reported two children who developed deformity of the extrahepatic duct 4 and 9 years after LDLT, respectively, but no clinical signs associated with the deformity were observed.…”

Section: Discussionmentioning

confidence: 96%

“…3 For pediatric LDLT, many researches have focused on the technical improvement to prevent adverse events related to regeneration of the partial graft and the growth of children. 5,6,9,10 However, biliary complications caused by these reasons do not commonly occur because Roux-en-Y hepaticojejunostomy remains the standard treatment of choice for pediatric LDLT, which may be less susceptible to bile duct deformity. A recent study by Yamamoto etal.…”

Section: Discussionmentioning

confidence: 99%

Bile duct kinking after adult living donor liver transplantation: Case reports and literature review

Wan

Xia

Zhang

et al. 2015

J of Digest Diseases

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Regeneration of the partial allograft and the growth of children may cause kinking of the biliary tract after pediatric living donor liver transplantation (LDLT), but bile duct kinking after adult LDLT is rarely reported. We herein presented two patients who suffered from anastomotic strictures caused by severe bile duct kinking after LDLT. The first patient was a 57-year-old woman with hepatitis B virus (HBV)-related liver cirrhosis, who developed biliary stricture 5 months after receiving right-lobe LDLT. Subsequently, endoscopic and percutaneous treatments were attempted, but both failed to solve the problem. The second was a 44-year-old woman also having HBV-related liver cirrhosis. Biliary stricture occurred 14 months after LDLT. Likewise, the guide wire failed to pass through the stricture when endoscopic interventions were conducted. Afterwards, both of the two cases underwent reexploration, showing that compensatory hypertrophy of the allografts resulted in kinking and sharp angulation of the bile ducts, and the anastomotic sites were found to be severely stenotic. Finally, re-anastomosis by Roux-en-Y procedure was successfully performed, and long-term stenosis-free survival was achieved in both of them. Our experience suggests that bile duct kinking after LDLT may play a role in the high incidence of anastomotic strictures in adult LDLT recipients, which may also result in the treatment failure of the non-surgical techniques for anastomotic strictures. Re-anastomosis in the form of Roux-en-Y hepaticojejunostomy is an effective surgical option for the treatment of such a condition.

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“…With DD reconstruction becoming increasingly common in adult liver transplantations, fresh data are beginning to accumulate about its implementations in pediatric patients. (1,3) A majority of these data covers living donor liver transplantation (LDLT) patients and to our best knowledge, there is no report on the outcomes of DD biliary reconstruction for pediatric patients in the setting of SLT.…”

Section: Discussionmentioning

confidence: 99%