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Individualized Biliary Reconstruction Techniques in Liver Transplantation: Five Years’ Experience of a Single Institution

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

To summarize the experience of individualized biliary reconstruction techniques in deceased donor liver transplantation and explore potential risk factors for biliary stricture.

Methods

We retrospectively collected medical records of 489 patients undergoing deceased donor liver transplantation at our center between January 2016 and August 2020. According to anatomical and pathological conditions of donor and recipient biliary ducts, patients’ biliary reconstruction methods were divided into six types. We summarized the experience of six different reconstruction methods and analyzed the biliary complications’ rate and risk factors after liver transplantation.

Results

Among 489 cases of biliary reconstruction methods during liver transplantation, there were 206 cases of type I, 98 cases of type II, 96 cases of type III, 39 cases of type IV, 34 cases of type V, and 16 cases of type VI. Biliary tract anastomotic complications occurred in 41 cases (8.4%), including 35 cases with biliary stricture (7.2%), 9 cases with biliary leakage (1.8%), 19 cases with biliary stones (3.9%), 1 case with biliary bleeding (0.2%), and 2 cases with biliary infection (0.4%). One of 41 patients died of biliary tract bleeding and one died of biliary infection. Thirty-six patients significantly improved after treatment, and 3 patients received secondary transplantation. Compared with patients without biliary stricture, a higher warm ischemic time was observed in patients with non-anastomotic stricture and more leakage of bile in patients with an anastomotic stricture.

Conclusion

The individualized biliary reconstruction methods are safe and feasible to decrease perioperative anastomotic biliary complications. Biliary leakage may contribute to anastomotic biliary stricture and cold ischemia time to non-anastomotic biliary stricture.

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Abbreviations

DDLT:

deceased donor liver transplantation

ERCP:

endoscopic retrograde cholangiopancreatography

MRCP:

magnetic resonance cholangiopancreatography

DCD:

donor after circulatory death

DBD:

donor after brain death

WIT:

warm ischemic time

CIT:

cold ischemic time

HTK:

histidine-tryptophan-ketoglutarate

UW:

the University of Wisconsin solution

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Acknowledgements

We would like to extend our sincere gratitude to Professor Dong Chen and Zhishui Chen for their instructive advice and valuable suggestions.

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Authors and Affiliations

  1. Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Key Laboratory of Organ Transplantation, Ministry of Education; NHC Key Laboratory of Organ Transplantation; Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Huazhong University of Science and Technology, 1905 Jiefang Avenue, Wuhan City, Hubei Province, China

    Lu Wang, Bo Yang, Hongmei Jiang, Lai Wei, Yuanyuan Zhao, Zhishui Chen & Dong Chen

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  1. Lu Wang
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  7. Dong Chen
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Contributions

All authors contributed to the study’s conception and design. Dong Chen and Zhishui Chen participated in research design; Lu Wang and Bo Yang participated in the writing of the paper and; Lai Wei and Yuanyuan Zhao participated in the performance of the research; Hongmei Jiang contributed to data collection; Lu Wang, Dong Chen, and Zhishui Chen participated in data analysis. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Zhishui Chen or Dong Chen.

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Ethics approval

This retrospective chart review study involving human participants followed the ethical standards of the institutional and national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ethics Committee of Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, approved this study.

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The authors declare no competing interests.

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Fig S1

The biliary anastomotic complications in the different types of surgical techniques. *P=0.017: the bile leakage rate was significantly higher in Type V than that in Type III; ns: the incidence of anastomosis stenosis(A), biliary leakage(B) and biliary stones(C) in six types of surgical techniques had no significance(P>0.05). (PNG 61 kb)

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Wang, L., Yang, B., Jiang, H. et al. Individualized Biliary Reconstruction Techniques in Liver Transplantation: Five Years’ Experience of a Single Institution. J Gastrointest Surg 27, 1188–1196 (2023). https://doi.org/10.1007/s11605-023-05657-1

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  • DOI: https://doi.org/10.1007/s11605-023-05657-1

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