Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

Surgical Technique of Biliary Reconstruction in Adult-to-Adult Living Donor Liver Transplantation: Survey of 9 Major Centers in Korea

생체간이식에서 담도 문합 방법: 국내 9개 간이식 병원 설문 조사 분석

  • Yi, Nam-Joon (Deparment of Surgery Seoul National University College of Medicine) ;
  • Kwon, Choon-Hyuck David (Deparment of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Keon-Kuk (Deparment of Surgery, Gachon Medical School, Gil Medical Center) ;
  • Kim, Bong-Wan (Deparment of Surgery, Ajou University Hospital, Ajou University School of Medicine) ;
  • You, Young-Kyoung (Deparment of Surgery, The Catholic University of Korea, College of Medicine) ;
  • Choi, Jin-Sub (Deparment of Surgery, Yonsei University College of Medicine) ;
  • Ha, Tae-Yong (Deparment of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Han, Young-Seok (Deparment of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Kwang-Woong (Deparment of Surgery, Seoul National University College of Medicine)
  • 이남준 (서울대학교 의과대학 외과학교실) ;
  • 권준혁 (성균관대학교 의과대학 삼성의료원 외과학교실) ;
  • 김건국 (가천의과학대학교 길병원 외과학교실) ;
  • 김봉완 (아주대학교 의과대학 아주대학교병원 외과학교실) ;
  • 유영경 (가톨릭대학교 의과대학 외과학교실) ;
  • 최진섭 (연세대학교 의과대학 외과학교실) ;
  • 하태용 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 한영석 (대구가톨릭대학교 의과대학 외과학교실) ;
  • 이광웅 (서울대학교 의과대학 외과학교실)
  • Published : 2010.12.31
⟨ Previous Next ⟩

Abstract

Purpose: Despite refinements in the surgical techniques for adult-to-adult living donor liver transplantation (ALDLT), biliary complications still remain the Achilles' heel of ALDLT. Moreover, there is no consensus for the ideal technique of biliary reconstruction to reduce the rate of complications to an acceptable range. We strove to collate the available data of the current surgical techniques for biliary reconstruction in ALDLT in Korea. Methods: A questionnaire concerning the surgical techniques for biliary reconstruction was sent to 9 surgeons who performed biliary anastomosis in the major LDLT centers of Korea (the response rate was 100%). Results: MR cholangiography (n=7) and/or intra-operative cholangiography (n=5) were routinely performed to evaluate the donor biliary anatomy. All the participants (n=9) preferred duct-to-duct anastomosis to hepatico-jejunostomy. Anastomosis was usually made on the whole layer (n=7 epithelium, n=2) of recipient's common hepatic duct under loupe magnification (n=8); only one center reconstructed the anastomosis on the $2^{nd}$ order hepatic duct under view of a surgical microscope. There were various techniques for biliary reconstruction as follows: suture material (absorbable: n=5, non-absorbable: n=4), suture method (continuous: n=4, interrupted: n=3, mixed: n=3) and the use of a biliary stent (routine: n=3, sometimes: n=5, rare: n=1). Ductoplasty was performed on the back table (n=7) for the cases with a very close distance (<5 mm) between the bile ducts' openings, but each duct was separately anastomosed to the recipients' bile duct (n=8) or a roux-en-Y limb (n=1) was done in cases with a distance more than 10 mm. Conclusion: In 9 LDLT centers of Koreas, duct-to-duct was preferred; however, there was no unique consensus, among the major centers, for the biliary reconstruction techniques that might reduce complications.

Keywords

References

  1. Furukawa H. Role of endoscopic retrograde cholangiopancreatography in late biliary tract complications after orthotopic liver transplantation. J Gastroenterol Hepatol 2000;15:577-578. https://doi.org/10.1046/j.1440-1746.2000.02218.x
  2. Calne RY. A new technique for biliary drainage in orthotopic liver transplantation utilizing the gall bladder as a pedicle graft conduit between the donor and recipient common bile ducts. Ann Surg 1976;184:605-609. https://doi.org/10.1097/00000658-197611000-00012
  3. Iida T, Ogura Y, Oike F, et al. Surgery-related morbidity in living donors for liver transplantation. Transplantation 2010;89:1276-1282. https://doi.org/10.1097/TP.0b013e3181d66c55
  4. Park JB, Kwon CH, Choi GS, et al. Prolonged cold ischemic time is a risk factor for biliary strictures in duct-to-duct biliary reconstruction in living donor liver transplantation. Transplantation 2008;86:1536-1542. https://doi.org/10.1097/TP.0b013e31818b2316
  5. Yi NJ, Suh KS, Cho JY, Kwon CH, Lee KU. In adult-to-adult living donor liver transplantation hepaticojejunostomy shows a better long-term outcome than duct-to-duct anastomosis. Transpl Int 2005;18:1240-1247. https://doi.org/10.1111/j.1432-2277.2005.00209.x
  6. Chang JH, Lee IS, Choi JY, et al. Biliary stricture after adult right-lobe living-donor liver transplantation with duct-to-duct anastomosis: longt-term outcome and Its related factors after endoscopic treatment. Gut Liver 2010;4:226-233. https://doi.org/10.5009/gnl.2010.4.2.226
  7. Hwang S, Lee SG, Sung KB, et al. Long-term incidence, risk factors, and management of biliary complications after adult living donor liver transplantation. Liver Transpl 2006;12: 831-838. https://doi.org/10.1002/lt.20693
  8. Shah SA, Grant DR, McGilvray ID, et al. Biliary strictures in 130 consecutive right lobe living donor liver transplant recipients: results of a Western center. Am J Transplant 2007;7:161-167. https://doi.org/10.1111/j.1600-6143.2006.01601.x
  9. Perkins JD. Biliary tract complications: the most common postoperative complication in living liver donors. Liver Transpl 2008;14:1372-1373. https://doi.org/10.1002/lt.21596
  10. Han JK. Radiologic diagnosis of benign biliary stricture. Korean J Hepatobiliary Pancreat Surg 2008;12:91-95.
  11. Kim BW, Bae BK, Lee JM, et al. Duct-to-duct biliary reconstructions and complications in 100 living donor liver transplantations. Transplant Proc 2009;41:1749-1755. https://doi.org/10.1016/j.transproceed.2009.02.097
  12. Kim SH, Lee KW, Kim YK, Cho SY, Han SS, Park SJ. Tailored telescopic reconstruction of the bile duct in living donor liver transplantation. Liver Transpl 2010;16:1069-1074. https://doi.org/10.1002/lt.22116
  13. Yi NJ, Suh KS, Lee HW, et al. An artificial vascular graft is a useful interpositional material for drainage of the right anterior section in living donor liver transplantation. Liver Transpl 2007;13:1159-1167. https://doi.org/10.1002/lt.21213
  14. Yi NJ, Suh KS, Lee HW, et al. Improved outcome of adult recipients with a high model for end-stage liver disease score and a small-for-size graft. Liver Transpl 2009;15:496-503. https://doi.org/10.1002/lt.21606
  15. Lee SG, Hwang S, Kim KH, et al. Toward 300 liver transplants a year. Surg Today 2009;39:367-373. https://doi.org/10.1007/s00595-008-3917-1
  16. Lee SG, Hwang S, Moon DB, et al. Expanded indication criteria of living donor liver transplantation for hepatocellular carcinoma at one large-volume center. Liver Transpl 2008;14:935-945. https://doi.org/10.1002/lt.21445
  17. Moon JI, Kwon CH, Joh JW, et al. Safety of small-for-size grafts in adult-to-adult living donor liver transplantation using the right lobe. Liver Transpl 2010;16:864-869. https://doi.org/10.1002/lt.22094
  18. Hwang S, Lee SG, Lee YJ, et al. Lessons learned from 1,000 living donor liver transplantations in a single center: how to make living donations safe. Liver Transpl 2006;12:920-927. https://doi.org/10.1002/lt.20734
  19. Yi NJ, Suh KS, Cho JY, et al. Three-quarters of right liver donors experienced postoperative complications. Liver Transpl 2007;13:797-806. https://doi.org/10.1002/lt.21030
  20. Kashyap R, Bozorgzadeh A, Abt P, et al. Stratifying risk of biliary complications in adult living donor liver transplantation by magnetic resonance cholangiography. Transplantation 2008;85:1569-1572. https://doi.org/10.1097/TP.0b013e31816ff21f
  21. Gunji H, Cho A, Tohma T, et al. The blood supply of the hilar bile duct and its relationship to the communicating arcade located between the right and left hepatic arteries. Am J Surg 2006;192:276-280. https://doi.org/10.1016/j.amjsurg.2006.01.046
  22. Liu CL, Lo CM, Chan SC, Tso WK, Fan ST. The right may not be always right: biliary anatomy contraindicates right lobe live donor liver transplantation. Liver Transpl 2004;10:811-812. https://doi.org/10.1002/lt.20193
  23. Marsh JW, Gray E, Ness R, Starzl TE. Complications of right lobe living donor liver transplantation. J Hepatol 2009;51:715-724. https://doi.org/10.1016/j.jhep.2009.04.023
  24. Fan ST, Lo CM, Liu CL, Tso WK, Wong J. Biliary reconstruction and complications of right lobe live donor liver transplantation. Ann Surg 2002;236:676-683. https://doi.org/10.1097/00000658-200211000-00019
  25. Lin TS, Concejero AM, Chen CL, et al. Routine microsurgical biliary reconstruction decreases early anastomotic complications in living donor liver transplantation. Liver Transpl 2009;15:1766-1775. https://doi.org/10.1002/lt.21947
  26. Lee KW, Joh JW, Kim SJ, et al. High hilar dissection: new technique to reduce biliary complication in living donor liver transplantation. Liver Transpl 2004;10:1158-1162. https://doi.org/10.1002/lt.20230
  27. Kasahara M, Egawa H, Takada Y, et al. Biliary reconstruction in right lobe living-donor liver transplantation: comparison of different techniques in 321 recipients. Ann Surg 2006;243: 559-566. https://doi.org/10.1097/01.sla.0000206419.65678.2e
  28. Azoulay D, Marin-Hargreaves G, Castaing D, ReneAdam, Bismuth H. Duct-to-duct biliary anastomosis in living related liver transplantation: the Paul Brousse technique. Arch Surg 2001;136:1197-1200. https://doi.org/10.1001/archsurg.136.10.1197