Biliary reconstruction in living donor liver transplantation: Technical invention and risk factor analysis for anastomotic stricture

Backgrounds. Bile duct complications especially biliary stricture remains a major cause of morbidity influencing the postoperative course in living donor liver transplantation (LDLT). The objectives of this study were to investigate the outcome of biliary reconstruction using "open-up" anastomotic technique and to clarify the risk factors for biliary stricture after LDLT. Patients and Methods. We retrospectively analyzed data of 83 consecutive adult patients who underwent LDLT between 1999 and 2007. Hepaticojejunostomy was conducted in 22 patients and duct-to-duct anastomosis in 61 patients. The "open-up" anastomotic technique was applied uniformly for biliary reconstruction. Results. The mean follow-up period after LDLT was 2.7±2.1 years (range, 0.01-7.52). Of the 83 recipients, six (7.2%) developed biliary strictures (four at anastomotic site and two at multiple intrahepatic sites), and one (1.2%) developed biliary leakage after hepaticojejunostomy. Risk factor analysis identified the diameter of donor bile duct and the use of right lateral sector as significant risk factors for biliary stricture at the anastomosis. Conclusions. Care should be taken when anastomosing a small bile duct of the donor graft or right lateral sector graft in LDLT because of the associated high incidence of biliary stenosis. Our technique, including the "open-up" procedure, ensures quality control for bile duct reconstruction and a better outcome after LDLT.