Multiple bile ducts (MBDs) in living donor liver transplantation (LDLT) remain a major technical challenge, particularly in right lobe grafts. This large retrospective study analysed 1,780 microsurgical biliary reconstructions over 16 years to determine optimal reconstruction strategies and outcomes.
Multiple bile ducts (MBDs) in living donor liver transplantation (LDLT) remain a major technical challenge, particularly in right lobe grafts. This large retrospective study analysed 1,780 microsurgical biliary reconstructions over 16 years to determine optimal reconstruction strategies and outcomes.
Approximately 23% of grafts had multiple bile ducts. Overall, biliary complications were higher in MBD grafts compared with single-duct grafts (14.7% vs 11.2%), driven mainly by increased bile leak rates (6.1% vs 2.1%), while stricture rates were similar. Among adult LDLT recipients with right lobe grafts, 2-to-2 duct-to-duct reconstructions had the highest complication rate (16.6%). In contrast, 2-to-2 duct-to-jejunum anastomoses showed no biliary complications in this cohort. Overall, duct-to-duct reconstruction was associated with significantly higher biliary complications than duct-to-jejunum anastomosis (12.5% vs 2.6%).
The study emphasises the importance of individualised surgical planning. Technical refinements—such as biliary stenting, ipsilateral duct alignment, figure-of-8 suturing at junctions, and centralisation techniques for size mismatch—may reduce complications.
For transplant surgeons, the key message is that duct-to-jejunum reconstruction should be strongly considered in grafts with multiple bile ducts, particularly in complex 2-to-2 configurations, as it may lower leak risk and improve early biliary outcomes.
Introduction: Bacterial infections remain a major cause of morbidity after liver transplantation despite advances in perioperative care. Synbiotics, combining probiotics and prebiotics, have been proposed to reduce postoperative infections by restoring gut microbiota and strengthening...
Introduction: Perioperative bleeding remains a major challenge during orthotopic liver transplantation (OLT), largely due to hyperfibrinolysis and coagulation abnormalities. Although tranexamic acid (TXA) effectively reduces bleeding in several surgical settings, its routine prophylactic use during...
Introduction: Liver transplantation is limited by a shortage of suitable donor organs. Current viability assessment relies on needle biopsy, which samples only a small portion of the liver and may miss important regional pathology. This...
Introduction: Bleeding remains a major challenge during liver transplantation despite advances in surgical techniques, anesthesia, and perioperative care. Antifibrinolytic agents have long been used to reduce intraoperative blood loss and transfusion requirements. However, evolving transplant...
Introduction: The demand for liver transplantation continues to exceed the availability of deceased donor organs, resulting in prolonged waiting times and preventable waitlist mortality. This perspective discusses how living donor liver transplantation (LDLT) can complement...
Introduction: Pediatric liver transplantation has achieved excellent survival rates, shifting the focus from graft survival alone to optimising long-term health, growth, neurodevelopment, and quality of life. This updated guideline provides evidence-based recommendations for comprehensive care...
We are pioneers in clinical intelligence, dedicated to helping gastroenterologists harness the power of artificial intelligence to drive precision, efficiency, and patient growth.