Background

Despite improvement of operative techniques and long term outcomes, biliary complication remains as a severe obstacle in living donor liver transplantation.

Methods

Medical records of 245 adult liver recipients who underwent living donor liver transplantation between September 2005 and December 2013 were retrospectively reviewed. Biliary complications according to the biliary reconstruction methods were analyzed. Biliary reconstruction types were Roux-en-Y hepaticojejunostomy (RYHJ), single duct-to-duct(SDD) anastomosis and multiple duct to duct anastomosis(MDD) including two bile duct to one bile duct, separated two bile duct, made one to one and triples.

Results

Of the 245 recipients, 90 (36.7%) patients had biliary complications including anastomotic bile leakages (n=12), non-anastomotic bile leakages (n=4), anastomotic biliary stricture (n=66), non-anastomotic biliary stricture (n=4). The incidences of anastomotic biliary complications were 0% in RYHJ group, 31% in SDD group and 42.9% in MDD group. (p=0.030). If graft liver containing multiple bile duct orifices, there was no significant difference of biliary complication rate between RYHJ group and MDD group (p=0.503). One patient underwent exploratory laparotomy because of internal herniation in RYHJ group

Conclusion

RYHJ had lower biliary complication rate than duct to duct anastomosis in this study. When the orifice of bile duct was more than 2, however, biliary complication rate of RYHJ was not significantly lower than that of duct to duct(multiple). Time consuming on procedure, non- physiologic passage, source of an ascending infection and internal herniation of RYHJ should be considered.

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