Introduction: Biliary complications are often referred to as the 'Achilles heel' of liver transplantation (LT) with their high incidence rate, the need for repeated and long treatment, and the potential effects on graft and patient survival. The main problem is the development of fibrosis in the anastomotic area. By decreasing the rate of fibroses on both sides, it is possible to prevent biliary complications from developing. In our experimental study on pigs, we were able to show that by using spiral polytetrafluoroethylene (PTFE) graft, the complication rates dropped to almost zero. As such, we now use this technique as standard procedure in a clinical setting. To date, we have performed this technique with PTFE graft in 13 patients. In this study we aimed to review the results.

Materials and Methods: Between December 8, 1988 and December, 2016 we performed 552 LT procedures at our centers (age range, 6 months – 64 years). Of these, 397 were living donor LT (71%), 155 were deceased donor LT (29%). We used PTFE graft in 13 patients. PTFE grafts were used in biliary stricture reconstruction after LT in 4 of these patients (Table 1) and in primary liver transplantation in the remaining patients (Table 2). All biliary anastomoses were performed with loop magnification. Proximal side of anastomosis performed first and end to end anastomosis performed between PTFE and graft bile duct. Distal anastomosis is performed in the same manner between spiral PTFE graft and native choledoch or jejenum.

Results: Four patients are doing well with normal liver function after biliary stricture reconstruction. Of the remaining 9 patients, 2 patients died due to sepsis with normal liver function. The remaining 7 patients are doing well with normal liver functions.

Conclusions: Biliary anastomosis using spiral PTFE graft is feasible with satisfactory anastomotic circumference and histologic evidence of healing. Our experimental studies as well as our small series of patients show that use of spiral PTFE graft is effective in reducing biliary complications in clinical transplantation.

CITATION INFORMATION: Ayvazoglu Soy E, Moray G, Torgay A, Ozdemir H, Haberal M. Results of Biliary Reconstruction with PTFE Graft in Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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