Impact of the site of arterial anastomosis on the risk of biliary complications after liver transplantation.

Biliary complications are an important cause of morbidity after orthotopic liver transplantation (OLT). It has been suggested that the denervation of recipient bile duct and the sphincter of Oddi may contribute to biliary complications. Recipient bile duct and the sphincter of Oddi receive its regulatory innervation through the nerve plexus around the gastroduodenal artery (GDA). These nerves are likely to be severed if recipient hepatic artery is divided at or proximal to the origin of GDA during arterial anastomosis of OLT (proximal arterial anastomosis). This study was carried out to determine the impact of the site of arterial anastomosis on the incidence of biliary complications. A total of 331 transplants by a single surgeon (JACB) were analysed. Patients with Roux-en-Y choledochoduodenostomy were excluded. Biliary complications were noted in 16.9% patients during first three months after transplantation. Incidence of biliary complications in patients with proximal and distal arterial anastomosis was found to be 17.2% and 12.9% respectively (ns). We conclude that the site of arterial anastomosis as an index of sphincter of Oddi denervation does not significantly influence the incidence of biliary complications.