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Outcome of routine use of microsurgical biliary reconstruction in pediatric living donor liver transplantation

  • Topics
  • Recent advances in pediatric hepatobiliary surgery
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Objective

Microsurgical techniques, initially used for hepatic artery reconstruction, have been extended to biliary reconstruction to decrease biliary complications. The routine use of microsurgical biliary reconstruction in pediatric living donor liver transplantation (LDLT) has not been elucidated.

Methods

Sixty-seven pediatric patients underwent primary LDLT. All biliary reconstructions were performed by a single microsurgeon using microsurgical techniques. A biliary stent was not used. The minimum follow-up was 12 months. Thirty-four patients had a minimum follow-up of 36 months. The outcomes of those who underwent microsurgical biliary reconstruction were compared with the outcomes of a cohort of 67 patients who underwent conventional biliary reconstruction.

Results

The demographical and clinical profiles of the two groups were not significantly different. There were 5 anastomotic complications in the conventional and 2 anastomotic complications in the microsurgical reconstruction groups. All complications developed within 90 days after transplant. There were no late biliary complications. Further analysis showed that conventional reconstruction increased the risk of biliary complications by 2.4 times (relative risk: 2.42; attributable risk: 4.5).

Conclusion

The routine use of microsurgical biliary reconstruction in pediatric LDLT is a technical innovation that led to decreased anastomotic biliary complications.

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References

  1. Chen CL, Wang KL, Lee MC, Chuang JH, Jan YY, Lin JN, et al. Liver transplantation for Wilson’s disease—report of the first successful liver transplant in Taiwan. Jpn J Transplant. 1987;22:178–84.

    CAS  Google Scholar 

  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;184:605–9.

    Article  PubMed  CAS  Google Scholar 

  3. Starzl TE, Putnam CW, Hansbrough JF, Porter KA, Reid HA. Biliary complications after liver transplantation with special reference to the biliary cast syndrome and techniques of secondary duct repair. Surgery. 1977;81:212–21.

    PubMed  CAS  Google Scholar 

  4. Ishiko T, Egawa H, Kasahara M, Nakamura T, Oike F, Kaihara S, et al. Duct-to-duct biliary reconstruction in living donor liver transplantation utilizing right lobe graft. Ann Surg. 2002;236:235–40.

    Article  PubMed  Google Scholar 

  5. Lin TS, Concejero AM, Chen CL, Chiang YC, Wang CC, Wang SH, et al. Routine microsurgical biliary reconstruction decreases early anastomotic complications in living donor liver transplantation. Liver Transpl. 2009;15:1766–75.

    Article  PubMed  Google Scholar 

  6. Chen CL, Concejero A, Wang CC, Wang SH, Lin CC, Liu YW, et al. Living donor liver transplantation for biliary atresia: a single-center experience with first 100 cases. Am J Transpl. 2006;6:2672–9.

    Article  Google Scholar 

  7. Lin TS, Chiang YC. Combined microvascular anastomosis: experimental and clinical experience. Ann Plast Surg. 2000;45:280–3.

    Article  PubMed  CAS  Google Scholar 

  8. Cardot C, Candinas D, Miza D, Gunson B, Davison S, Murphy MS, et al. Biliary complications after paediatric liver transplantation: Birmingham’s experience. Transpl Int. 1995;8:133–40.

    Article  Google Scholar 

  9. Rogiers X, Malago M, Nollkemper D, Sterneck M, Burdelski M, Broelsch CE. The Hamburg liver transplant program. Clin Transpl. 1997;17:183–90.

    Google Scholar 

  10. Kiuchi T, Inomata Y, Uemoto Y. Living donor liver transplantation in Kyoto, 1997. In: Cecka PI, Terasaki JM, editors. Clinical Transplants. Los Angeles: University of California at Los Angeles; 1997. p. 191–8.

    Google Scholar 

  11. Cronin D, Alonso EM, Piper JB, Newell KA, Bruce DS, Woodle ES, et al. Biliary complications in liver transplantation. Transpl Proc. 1997;29:419–20.

    Article  Google Scholar 

  12. Lamesch AJ, Dociu N. Microsurgical reconstruction of the biliary duct: experimental study in rats and dogs. Microsurgery. 1986;7:45–52.

    Google Scholar 

  13. Yan L, Li B, Zeng Y, Wen T, Zhao J, Wang W, et al. Introduction of microsurgical technique to biliary reconstruction in living donor liver transplantation. Transpl Proc. 2007;39:1513–6.

    Article  CAS  Google Scholar 

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Correspondence to Chao-Long Chen.

Additional information

C.-L. Chen and A. M. Concejero contributed equally in the preparation of this manuscript.

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Chen, CL., Concejero, A.M., Lin, TS. et al. Outcome of routine use of microsurgical biliary reconstruction in pediatric living donor liver transplantation. J Hepatobiliary Pancreat Sci 20, 492–497 (2013). https://doi.org/10.1007/s00534-013-0609-z

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  • DOI: https://doi.org/10.1007/s00534-013-0609-z

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