Routine microsurgical biliary reconstruction decreases early anastomotic complications in living donor liver transplantation

Authors

  • Tsan-Shiun Lin,

    1. Liver Transplantation Program, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Surgery, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    Search for more papers by this author
    • These authors contributed equally to this study.

  • Allan M. Concejero,

    1. Liver Transplantation Program, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Surgery, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    Search for more papers by this author
    • These authors contributed equally to this study.

  • Chao-Long Chen,

    Corresponding author
    1. Liver Transplantation Program, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Surgery, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    • Department of Surgery, Chang Gung Memorial Hospital–Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan
    Search for more papers by this author
    • Telephone: +886-7-731-7123, extension 8097; FAX: +887-7-732-4855

  • Yuan-Cheng Chiang,

    1. Liver Transplantation Program, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Surgery, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    Search for more papers by this author
  • Chih-Chi Wang,

    1. Liver Transplantation Program, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Surgery, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    Search for more papers by this author
  • Shih-Ho Wang,

    1. Liver Transplantation Program, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Surgery, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    Search for more papers by this author
  • Yueh-Wei Liu,

    1. Liver Transplantation Program, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Surgery, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    Search for more papers by this author
  • Chin-Hsiang Yang,

    1. Liver Transplantation Program, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Surgery, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    Search for more papers by this author
  • Chee-Chien Yong,

    1. Liver Transplantation Program, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Surgery, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    Search for more papers by this author
  • Bruno Jawan,

    1. Liver Transplantation Program, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Anesthesiology, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    Search for more papers by this author
  • Yu-Fan Cheng

    1. Liver Transplantation Program, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Diagnostic Radiology, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    Search for more papers by this author

Abstract

Biliary reconstruction using a microsurgical technique in living donor liver transplantation was routinely performed on 88 grafts primarily transplanted into 85 patients. All procedures were performed under a microscope by a single microsurgeon. Except for biliary atresia and Alagille syndrome, duct-to-duct reconstruction was performed. Stents were not used. The outcomes with microsurgical biliary reconstruction (MB) were compared with the outcomes of a cohort of 86 grafts in 85 patients that underwent conventional biliary reconstruction (CB). The identification of complications included only up to 12 months of follow-up for each recipient in both groups. The average graft duct sizes were 2.8 mm for MB and 3.4 mm for CB. Most complications occurred in the first 15 cases with MB, and these cases were considered to constitute the learning curve phase. The MB complication rate was 46.7% in the first 15 cases, 20.0% in the next 15 cases, and 5.4% in the last 55 cases. When the learning curve phase was excluded, the overall complication rate over time with MB (8.9%) was significantly lower than that with CB (21.9%). CB increased the risk of biliary complications by 2.5 times (relative risk: 2.5; attributable risk: 128; odds ratio: 2.9). In conclusion, routine MB is a technical innovation that leads to decreased early anastomotic complications in living donor liver transplantation. Liver Transpl 15:1766–1775, 2009. © 2009 AASLD.

Ancillary