Using the Cystic Duct for Biliary Reconstruction in Dual-Graft Living Donor Liver Transplantation: A Case Report |
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| Affiliation: | 1. Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan;2. Department of Nursing, Changhua Christian Hospital, Changhua, Taiwan;1. University of Utah Health, Salt Lake City, Utah;2. Adventist Health White Memorial, Los Angeles, California;3. Moffitt Cancer Center, Tampa, Florida;1. Nephrology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal;2. Nephrology Department, Hospital Beatriz Ângelo, Loures, Portugal;3. Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal;4. Hematology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.;1. Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York;2. Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York;3. Lung Transplant Program, Columbia University Irving Medical Center, New York, New York;4. Section of Thoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York |
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| Abstract: | In Taiwan, living donor liver transplant (LDLT) has accounted for the majority of liver transplantation due to organ shortage. Dual-graft LDLT is a feasible way to resolve the insufficient graft size and remnant liver in donors. We presented a heavy-weight patient underwent dual-graft LDLT, and cystic duct was used to resolve the inadequate bile duct length and limited appropriate position in dual-graft LDLT. We harvested a right lobe graft (segment 5, 6, 7, and 8 without middle hepatic vein) and a left lobe graft (segment 1, 2, 3, and 4 without middle hepatic vein) stepwise, and placed the grafts orthotopically. For proper tension and length of biliary reconstruction, we anastomosed the right intrahepatic duct of the right lobe graft to cystic duct of the recipient. Before the biliary reconstruction, the metal probe was inserted in the lumen of cystic duct in recipient to ensure the patency and destroy the Heister valve of cystic duct, then the internal biliary stent (5 Fr pediatric feeding tube) was placed in the donor's right intrahepatic duct to recipient's cystic duct and common bile duct, which allows the endoscopic removal of the internal stent. The patient has survived more than 16 months with normal liver function. |
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