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Hepaticojejunostomy in Orthotopic Liver Transplant: A Retrospective Case Control Study.

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Transplantation Proceedings
|January 22, 2019
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Roux-en-Y hepaticojejunostomy in liver transplants involves longer surgery but has similar biliary complication rates compared to end-to-end coledoco-coledocostomy. This technique is often used for complex cases like cholestatic disease or retransplants.

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Area of Science:

  • Hepatobiliary Surgery
  • Transplantation Medicine
  • Gastroenterology

Background:

  • Biliary complications after deceased donor liver transplantation can reach 30%.
  • Roux-en-Y hepaticojejunostomy is sometimes necessary for biliary reconstruction.
  • Orthotopic liver transplantation outcomes vary based on biliary reconstruction techniques.

Purpose of the Study:

  • To compare the outcomes of orthotopic liver transplantation based on the biliary reconstruction technique used.
  • To evaluate the efficacy and safety of hepaticojejunostomy versus end-to-end coledoco-coledocostomy.

Main Methods:

  • Retrospective analysis of 1000 consecutive orthotopic liver transplants (1996-2013).
  • Matched case-control study (1:3 ratio) comparing hepaticojejunostomy (n=47) and end-to-end coledoco-coledocostomy (n=136).
  • Follow-up data collected until 2017.

Main Results:

  • Hepaticojejunostomy was more frequently used in patients with cholestatic/ischemic diseases and previous transplants.
  • Longer operative times, biliary reconstruction, and cold ischemia were noted for hepaticojejunostomy.
  • Vascular complications, particularly arterial, were higher with hepaticojejunostomy (36.1% vs 10.4%).
  • No significant differences in overall biliary complication rates (21.2% vs 16.9%), biliary leakage, or stricture rates were observed between the groups.
  • Graft survival rates were similar between the two techniques.

Conclusions:

  • Hepaticojejunostomy in orthotopic liver transplantation is associated with increased surgical time and vascular complications but similar biliary complication rates and graft survival compared to end-to-end coledoco-coledocostomy.
  • The observed differences are likely due to the more frequent use of hepaticojejunostomy in complex patient profiles, including those with cholestatic/ischemic diseases and retransplants.