Increased risk of bile duct complications for some living donor liver transplantation recipients

With a critical shortage of donated organs, living donor liver transplantation (LDLT) has become widely accepted in the US as a potential alternative to deceased organ transplant. However, LDLT is a technically challenging procedure that requires sophisticated training, which has limited the growth of LDLT programs. To add to the knowledge in this area and help guide surgical decisions, researchers compared outcomes and complications after surgery for different LDLT approaches.

Data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) provided a unique opportunity to compare surgical approaches in centers across North America in a real-world setting. Investigators focused mainly on the reconstruction technique used to replace the bile delivery system in the recipient liver.

"The composite A2ALL experience gave us a novel database, with a range of anatomic variants in donors and recipients and with reconstruction approaches driven by surgeon preference and experience,” added lead author Dr. Talia B. Baker.

They found that recipients with reconstruction using high biliary radicals had the highest probability of developing a biliary complication, including early biliary leaks and late biliary strictures. Simple duct-to-duct reconstruction was associated with a lower risk of biliary leaks or strictures. The highest rates for associated vascular complications, particularly hepatic artery thrombosis, were among recipients with a Roux-en-Y or a combination of Roux-en-Y and duct-to-duct reconstruction.

"The bile duct is widely acknowledged to be the 'Achilles' heel' of liver transplantation,” said Dr. Baker. “Our research adds important findings regarding outcomes related to the relationship between vascular and biliary anatomic variants and reconstruction techniques."

Ultimately, this information may help improve surgical outcomes in LDLT and reduce technical complications after transplantation.

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CITATION:Baker TB, Zimmerman MA, Goodrich NP, Samstein B, Pomfret EA, Pomposelli JJ, Gillespie BW, Berg CL, Emond JC, Merion RM. Biliary Reconstructive Techniques and Associated Anatomic Variants In Adult Living Donor Liver Transplants: The A2ALL Experience. Liver Transpl. 2017 November 20. doi: 10.1002/lt.24872. [Epub ahead of print]
PubMed:www.ncbi.nlm.nih.gov/pubmed/28926171
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