Eversion technique to prevent biliary stricture after living donor liver transplantation in the universal minimal hilar dissection era

Toru Ikegami, Tomonari Shimagaki, Junji Kawasaki, Tomoharu Yoshizumi, Hideaki Uchiyama, Noboru Harada, Norifumi Harimoto, Shinji Itoh, Yuji Soejima, Yoshihiko Maehara

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Abstract

Background. Biliary anastomosis stricture (BAS) is still among the major concerns after living donor liver transplantation (LDLT), even after the technical refinements including the universal use of the blood flow-preserving hilar dissection technique. The aim of this study is to investigate what are still the factors for BAS after LDLT. Methods. An analysis of 279 adult-to-adult LDLT grafts (left lobe, n = 161; right lobe, n = 118) with duct-to-duct biliary reconstruction, since the universal application of minimal hilar dissection technique and gradual introduction of eversion technique, was performed. Results. There were 39 patients with BAS. Univariate analysis showed that a right lobe graft (P = 0.008), multiple bile ducts (P < 0.001), ductoplasty (P < 0.001), not using the eversion technique (P = 0.004) and fewer biliary stents than bile duct orifices (P = 0.002) were among the factors associated with BAS. The 1-year and 5-year BAS survival rates were 17.7% and 21.2% in the noneversion group (n = 134), and 6.2% and 7.9% in the eversion group (n = 145), respectively (P = 0.002). The perioperative factors including graft biliary anatomy were not different between everted (n = 134) and noneverted (n = 145) patients. Conclusions. The application of eversion technique under minimal hilar dissection technique could be a key for preventing BAS in duct-to-duct biliary reconstruction in LDLT.

Original languageEnglish
Pages (from-to)e20-e25
JournalTransplantation
Volume101
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

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Living Donors
Liver Transplantation
Dissection
Pathologic Constriction
Bile Ducts
Transplants
Stents
Anatomy
Survival Rate

All Science Journal Classification (ASJC) codes

  • Transplantation

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Eversion technique to prevent biliary stricture after living donor liver transplantation in the universal minimal hilar dissection era. / Ikegami, Toru; Shimagaki, Tomonari; Kawasaki, Junji; Yoshizumi, Tomoharu; Uchiyama, Hideaki; Harada, Noboru; Harimoto, Norifumi; Itoh, Shinji; Soejima, Yuji; Maehara, Yoshihiko.

In: Transplantation, Vol. 101, No. 1, 01.01.2017, p. e20-e25.

Research output: Contribution to journalArticle

Ikegami, Toru ; Shimagaki, Tomonari ; Kawasaki, Junji ; Yoshizumi, Tomoharu ; Uchiyama, Hideaki ; Harada, Noboru ; Harimoto, Norifumi ; Itoh, Shinji ; Soejima, Yuji ; Maehara, Yoshihiko. / Eversion technique to prevent biliary stricture after living donor liver transplantation in the universal minimal hilar dissection era. In: Transplantation. 2017 ; Vol. 101, No. 1. pp. e20-e25.
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abstract = "Background. Biliary anastomosis stricture (BAS) is still among the major concerns after living donor liver transplantation (LDLT), even after the technical refinements including the universal use of the blood flow-preserving hilar dissection technique. The aim of this study is to investigate what are still the factors for BAS after LDLT. Methods. An analysis of 279 adult-to-adult LDLT grafts (left lobe, n = 161; right lobe, n = 118) with duct-to-duct biliary reconstruction, since the universal application of minimal hilar dissection technique and gradual introduction of eversion technique, was performed. Results. There were 39 patients with BAS. Univariate analysis showed that a right lobe graft (P = 0.008), multiple bile ducts (P < 0.001), ductoplasty (P < 0.001), not using the eversion technique (P = 0.004) and fewer biliary stents than bile duct orifices (P = 0.002) were among the factors associated with BAS. The 1-year and 5-year BAS survival rates were 17.7{\%} and 21.2{\%} in the noneversion group (n = 134), and 6.2{\%} and 7.9{\%} in the eversion group (n = 145), respectively (P = 0.002). The perioperative factors including graft biliary anatomy were not different between everted (n = 134) and noneverted (n = 145) patients. Conclusions. The application of eversion technique under minimal hilar dissection technique could be a key for preventing BAS in duct-to-duct biliary reconstruction in LDLT.",
author = "Toru Ikegami and Tomonari Shimagaki and Junji Kawasaki and Tomoharu Yoshizumi and Hideaki Uchiyama and Noboru Harada and Norifumi Harimoto and Shinji Itoh and Yuji Soejima and Yoshihiko Maehara",
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AU - Kawasaki, Junji

AU - Yoshizumi, Tomoharu

AU - Uchiyama, Hideaki

AU - Harada, Noboru

AU - Harimoto, Norifumi

AU - Itoh, Shinji

AU - Soejima, Yuji

AU - Maehara, Yoshihiko

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N2 - Background. Biliary anastomosis stricture (BAS) is still among the major concerns after living donor liver transplantation (LDLT), even after the technical refinements including the universal use of the blood flow-preserving hilar dissection technique. The aim of this study is to investigate what are still the factors for BAS after LDLT. Methods. An analysis of 279 adult-to-adult LDLT grafts (left lobe, n = 161; right lobe, n = 118) with duct-to-duct biliary reconstruction, since the universal application of minimal hilar dissection technique and gradual introduction of eversion technique, was performed. Results. There were 39 patients with BAS. Univariate analysis showed that a right lobe graft (P = 0.008), multiple bile ducts (P < 0.001), ductoplasty (P < 0.001), not using the eversion technique (P = 0.004) and fewer biliary stents than bile duct orifices (P = 0.002) were among the factors associated with BAS. The 1-year and 5-year BAS survival rates were 17.7% and 21.2% in the noneversion group (n = 134), and 6.2% and 7.9% in the eversion group (n = 145), respectively (P = 0.002). The perioperative factors including graft biliary anatomy were not different between everted (n = 134) and noneverted (n = 145) patients. Conclusions. The application of eversion technique under minimal hilar dissection technique could be a key for preventing BAS in duct-to-duct biliary reconstruction in LDLT.

AB - Background. Biliary anastomosis stricture (BAS) is still among the major concerns after living donor liver transplantation (LDLT), even after the technical refinements including the universal use of the blood flow-preserving hilar dissection technique. The aim of this study is to investigate what are still the factors for BAS after LDLT. Methods. An analysis of 279 adult-to-adult LDLT grafts (left lobe, n = 161; right lobe, n = 118) with duct-to-duct biliary reconstruction, since the universal application of minimal hilar dissection technique and gradual introduction of eversion technique, was performed. Results. There were 39 patients with BAS. Univariate analysis showed that a right lobe graft (P = 0.008), multiple bile ducts (P < 0.001), ductoplasty (P < 0.001), not using the eversion technique (P = 0.004) and fewer biliary stents than bile duct orifices (P = 0.002) were among the factors associated with BAS. The 1-year and 5-year BAS survival rates were 17.7% and 21.2% in the noneversion group (n = 134), and 6.2% and 7.9% in the eversion group (n = 145), respectively (P = 0.002). The perioperative factors including graft biliary anatomy were not different between everted (n = 134) and noneverted (n = 145) patients. Conclusions. The application of eversion technique under minimal hilar dissection technique could be a key for preventing BAS in duct-to-duct biliary reconstruction in LDLT.

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