Department of Surgery, University of Hong Kong, Hong Kong, China.
Liver Transpl. 2011 Jan;17(1):47-52. doi: 10.1002/lt.22188.
Duct-to-duct anastomosis (DDA) and hepaticojejunostomy (HJ) are options for biliary reconstruction in patients undergoing adult-to-adult right lobe living donor liver transplantation (ARLDLT), after which biliary anastomotic stricture (BAS) is common as a complication. The risk factors for BAS are not clearly defined. We aimed to determine the rate of post-ARLDLT BAS in our center and its associated factors. In 265 ARLDLT recipients, 55 (20.8%) developed postoperative BAS. The diagnosis was based on clinical, biochemical, histological, and radiological results. The BAS rates were 21.4% (43/201) for recipients undergoing DDA during transplantation, 18.9% (10/53) for recipients undergoing HJ, and 18.2% (2/11) for recipients undergoing both procedures. BAS and non-BAS patients had comparable demographics. The number of graft bile duct openings (P = 0.516) and the size of the graft's smallest bile duct (5 versus 5 mm, P = 0.4) were not significantly different between BAS and non-BAS patients. Univariate analysis showed that the factors associated with postoperative BAS were the recipient warm ischemia time (55 versus 51 minutes, P = 0.026), graft cold ischemia time (120 versus 108 minutes, P = 0.046), stent use (21.8% versus 7.1%, P = 0.001), postoperative acute cellular rejection (29.1% versus 11.0%, P = 0.001), and University of Wisconsin solution use (21.8% versus 7.1%, P = 0.001). Multivariate analysis showed that the cold ischemia time (odds ratio = 1.012, 95% confidence interval = 1.002-1.023, P = 0.014) and acute rejection (odds ratio = 3.180, 95% confidence interval = 1.606-6.853, P = 0.002) were significant factors. The graft survival rates of BAS and non-BAS patients were comparable. One patient required retransplantation for secondary biliary cirrhosis. In conclusion, BAS remains common after ARLDLT regardless of DDA or HJ. The graft cold ischemia time and postoperative acute cellular rejection are significantly associated with postoperative BAS.
胆管对胆管吻合术（DDA）和胆肠吻合术（HJ）是成人对成人右半活体肝移植（ARLDLT）后胆道重建的选择，此后胆道吻合口狭窄（BAS）是常见的并发症。BAS 的危险因素尚不清楚。我们旨在确定本中心 ARDLDLT 后 BAS 的发生率及其相关因素。在 265 名 ARLDLT 受者中，55 名（20.8%）发生术后 BAS。诊断基于临床、生化、组织学和影像学结果。DDA 组 BAS 发生率为 21.4%（43/201），HJ 组为 18.9%（10/53），两种手术均行的为 18.2%（2/11）。BAS 和非 BAS 患者的人口统计学特征无差异。BAS 患者和非 BAS 患者的移植胆管开口数量（P=0.516）和移植胆管最小直径（5 毫米比 5 毫米，P=0.4）无显著差异。单因素分析显示，与术后 BAS 相关的因素是受体热缺血时间（55 分钟比 51 分钟，P=0.026）、供体冷缺血时间（120 分钟比 108 分钟，P=0.046）、支架使用（21.8%比 7.1%，P=0.001）、术后急性细胞排斥（29.1%比 11.0%，P=0.001）和威斯康星大学溶液使用（21.8%比 7.1%，P=0.001）。多因素分析显示，冷缺血时间（比值比=1.012，95%置信区间=1.002-1.023，P=0.014）和急性排斥（比值比=3.180，95%置信区间=1.606-6.853，P=0.002）是显著因素。BAS 患者和非 BAS 患者的移植物存活率相当。1 例因继发性胆汁性肝硬化需要再次肝移植。总之，无论行 DDA 还是 HJ，ARLDLT 后 BAS 仍然常见。供体冷缺血时间和术后急性细胞排斥与术后 BAS 显著相关。
