Reconstruction of Separated Intrahepatic Ducts Using the Cystic and Common Hepatic Ducts in Right-Lobe Living-Donor Liver Transplantation: Experiences of Surgical Techniques, Biliary Complications, and Outcomes in a Single Institution

Po Jung Hsu, Hao Chien Hung, Ching Sung Lee, Kuang Tse Pan, Jin Chiao Lee, Yu Chao Wang, Chih Hsien Cheng, Tsung Han Wu, Chen Fang Lee, Hong Shiue Chou, Kun Ming Chan, Wei Chen Lee, Ting Jung Wu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

Abstract

Background: Duct-to-duct biliary reconstruction has been increasingly used in living-donor liver transplantation. Information regarding dual duct-to-duct biliary anastomoses is limited. We present the largest case series to date on the use of the cystic and common hepatic ducts as dual-ductal anastomosis, along with long-term follow-up results. Material/Methods: In this study, 740 patients underwent right-lobe living-donor liver transplantation; 56 of them were documented as dual-ductal anastomoses. We analyzed recipient and donor characteristics, surgical procedures, appearance of biliary complications, corresponding interventions, and long-term biliary outcomes. Results: Cystic and common hepatic ducts were utilized in 56 cases of dual-ductal biliary reconstruction, which we categorized into 2 types: A (78.6%), in which the right anterior intrahepatic duct was anastomosed to the common hepatic duct and the right posterior intrahepatic duct to the cystic duct; and B (21.4%), which was the reverse of A. After a median follow-up period of 46.4 months, 23 patients (41.1%) experienced complications, including biliary leakage and biliary stricture. However, after aggressive intervention (patent biliary anastomosis in most of them), 50 of 56 patients (89.3%) had patent biliary anastomosis and restored normal liver function at the end of follow-up. A small graft (graft-to-recipient weight ratio <0.9%) was the only predictor of biliary complications after multivariate analysis. Conclusions: Dual-ductal biliary reconstruction in adult right-lobe living-donor liver transplantation is challenging but feasible. Our findings support the use of the cystic duct for reconstruction in selected patients. Good long-term results can be achieved with adequate management of patients with biliary complications.

Original languageEnglish
Article numbere934459
JournalAnnals of Transplantation
Volume27
DOIs
StatePublished - 2022

Bibliographical note

Publisher Copyright:
© Ann Transplant, 2022.

Keywords

  • Biliary Tract
  • Cystic Duct
  • Living Donors

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