Conflict of Interest No conflict of interests.
Duct-to-duct biliary reconstruction in orthotopic liver transplantation for primary sclerosing cholangitis: a viable and safe alternative
Article first published online: 22 OCT 2011
© 2011 The Authors. Transplant International © 2011 European Society for Organ Transplantation
Volume 25, Issue 1, pages 64–68, January 2012
How to Cite
Damrah, O., Sharma, D., Burroughs, A., Rolando, N., Fernando, B., Davidson, B. and Rolles, K. (2012), Duct-to-duct biliary reconstruction in orthotopic liver transplantation for primary sclerosing cholangitis: a viable and safe alternative. Transplant International, 25: 64–68. doi: 10.1111/j.1432-2277.2011.01371.x
- Issue published online: 16 DEC 2011
- Article first published online: 22 OCT 2011
- Received: 17 May 2011 Revision requested: 20 June 2011 Accepted: 25 September 2011 Published online: 22 October 2011
- biliary reconstruction;
- orthotopic liver transplantation;
- primary sclerosing cholangitis
Roux-en-Y loop is considered the reconstruction method of choice in Orthotopic Liver Transplantation (OLT) for Primary Sclerosing Cholangitis (PSC). We have adopted an approach of duct-to-duct (D-D) reconstruction when recipient common bile duct is free of gross disease. Patients were divided into two groups: patients who underwent a Roux-en-Y choledochojejunostomy and patients who had a D-D anastomosis. Morbidity, mortality, disease recurrence and graft and patient survival were compared between the two groups and analyzed. Ninety-one patients had OLT for PSC. Sixty-three patients underwent a D-D biliary reconstruction, whereas 28 patients had a Roux-en-Y loop. Biliary leak complicated 8% from the D-D group, and 14% from the Roux-en-Y group (P = 0.08), whereas biliary strictures were identified in 10% vs. 7% patients from the D-D and Roux-en-Y group, respectively (P = 0.9). Actuarial 1, 3 and 10 year survival for D-D and Roux-en-Y group was (87%, 80% and 62%) and (82%, 73% and 73%), respectively (P = 0.7). The corresponding 1, 3 and 10 year graft survival was (72%, 58% and 42%) and (67%, 58% and 53%), respectively (P = 0.6). No difference was seen in disease recurrence rates. D-D biliary reconstruction in OLT for selected PSC patients remains our first option of reconstruction.