*Purpose: Multiple small size donor bile ducts (BDs) are related to higher incidence of biliary complications (BCs) and biliary reconstruction for multiple BDs still remains technical challenge during living donor liver transplantation (LDLT). Especially, biliary reconstructions using high biliary radicals (right and left hepatic duct) on the recipient for multiple BDs have very high probability of BCs secondary to devacularization and ischemia. Therefore, hepaticojejunostomy has been preferred in cases with multiple BDs which are not close together or impossible to simple duct to duct anastomosis (DDA) even though DDA has more physiologic advantages.

*Methods: We analyzed clinical outcomes through retrospective reviews 227 patients receiving DDA for LDLT with right lobe grafts from January 2013 to September 2018. 87 LDLT using grafts with multiple BDs have been performed and 39 patients received DDA using high biliary radicals among them. Actually, our strategies for biliary reconstruction using high biliary radicals are minimal hilar dissection, external biliary stents and mucosal eversion technique. We compared clinical outcomes between these patients and those receiving DDA using common hepatic duct as recipient ducts for multiple BD (CHD group).

*Results: The incidence of biliary leakage and stricture were 10.3% and 12.8% and these results were not different to those in CHD group. Overall patient and graft survival were similar between the two groups. Moreover, these results were comparable to those in single duct groups with DDA during the same period.

*Conclusions: The choice to use high biliary radicals on the recipient duct for multiple graft BDs was not associated with more BCs and could be safe option for biliary reconstruction with multiple BDs under our strategies.

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