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Portojejunostomy in Split Liver Transplantation as a Rescue Technique for Challenging Biliary Reconstruction: A Case
M Spaggiari1, H Mashbari1, C Di Bella1
1Division of Transplantation, General Surgery Department, University of Illinois at Chicago, Chicago, Illinois, USA.
Transplantation Proceedings
|March 19, 2019
Summary
Split liver transplantation (SLT) offers two grafts from one donor. A novel portoenterostomy technique successfully managed complex biliary leaks after adult cadaveric SLT, avoiding retransplantation.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Immunology
- Surgical Innovation
Background:
- Cadaveric split liver transplantation (SLT) expands organ availability, typically for adult-pediatric pairs.
- Recent advances in living donor liver transplantation have made splitting cadaveric livers for two adult recipients feasible.
- Biliary complications are a significant challenge in partial liver grafts, impacting patient outcomes.
Observation:
- A case of cadaveric SLT in two adult recipients presented with a complex biliary leak due to multiple bile ducts.
- Standard biliary reconstruction methods, including duct-to-duct anastomosis and hepaticojejunostomy, failed to resolve the high-output leak.
- The patient's unique biliary anatomy precluded interventional radiology or endoscopic management.
Findings:
- A portoenterostomy was successfully performed to restore bilioenteric continuity, effectively managing the persistent biliary leak.
- This intervention served as a last resort, successfully averting the need for liver retransplantation.
- The case highlights portoenterostomy as a viable, albeit last-option, solution for complex biliary complications post-SLT.
Implications:
- Portoenterostomy represents a critical salvage technique for complex biliary reconstruction failures in partial liver transplantation.
- Successful management of biliary leaks through portoenterostomy can improve graft survival and reduce retransplantation rates.
- Further research into optimizing portoenterostomy for challenging biliary anatomies in SLT is warranted.
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