Biliary Anastomosis in Living Related Liver Transplantation Using the Right Liver Lobe: Techniques and Complications |
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| Affiliation: | 1. Surgical Unit 2, Hepatobiliary-Pancreatic and Digestive, San Paolo Hospital, University of Milan, Italy;2. Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Créteil, France;3. Division of Gastrointestinal and Endocrine Surgery, Columbia College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, USA;4. Hepato-Biliary Centre, AP-HP Hospital Paul Brousse, Villejuif, France;5. Humanitas University Medicine and Humanitas Research Hospital, Rozzano, Milano, Italy;6. Department of Oncological Abdominal Surgery, National Tumour Institute “G. Pascale”, Naples, Italy;1. Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain;2. Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain;1. Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117 Germany;2. Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117 Germany;3. Department of Neurology, Jüdisches Krankenhaus Berlin, Heinz-Galinski-Strasse 1, Berlin, 13347 Germany;4. Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117 Germany;1. Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA;2. Department of Urology, Yale School of Medicine, New Haven, CT;3. David Geffen School of Medicine at UCLA, Los Angeles, CA |
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| Abstract: | Since the introduction of adult-to-adult living donor liver transplantation using the right lobe of the liver, biliary problems have led the list of complications resulting in postoperative morbidity. We report our experience with the first 30 living donor liver transplantations performed in our institution from August 1998 to January 2000. Patients were 21 men and 9 women, with a mean age 45 ± 16 years. Mean recipient weight was 65.1 ± 17.9 kg, mean graft weight was 877 ± 146 g, and the mean graft-recipient weight ratio was 1.5 ± 0.6. Patient and graft survival rates were 83.3% and 80%, respectively. Biliary anastomosis was either an end-to-end hepaticocholedochostomy with a T-drain or hepaticojejunostomy. Mean follow-up was 217.4 ± 149.8 days. The overall complication rate was 26.6% (8 of 30 procedures) and was directly correlated to the type of anastomosis and number of bile ducts. Surgical revision was necessary in all cases. Biliary complications were not the primary cause of graft loss. Adult living donor liver transplantation using the right lobe is a successful procedure, with graft and patient survival similar to those in cadaver full-organ transplantation. Postoperative morbidity, mainly caused by biliary leak, was directly related to the number of ducts and type of anastomosis. With increasing experience, we have better defined our plane of transection on the hilar plate, with the goal of obtaining only 1 biliary duct for the anastomosis. We also improved our parenchymal transection technique, which resulted in a decreased incidence of leak at the cut-surface area. (Liver Transpl 2000;6:710-714.) |
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