NIV Congres

Background Although duct-to-duct anastomosis has been shown as a feasible option for biliary reconstruction in patients undergoing orthotopic liver transplantation (OLT) for end-stage primary sclerosing cholangitis (PSC), it remains unclear whether there is any difference in long-term outcome compared with biliary reconstruction using a Roux-en-Y hepatico-jejunostomy.

Aim The aim of this study was to evaluate the long-term outcome after OLT for PSC using either duct-to-duct anastomosis or Roux-en-Y hepatico-jejunostomy for biliary reconstruction.

Methods Between January 1, 1991 and December 31, 2011, a total of 98 adult patients underwent OLT for PSC in our center with either a duct-to-duct anastomosis or a Roux-en-Y hepatico-jejunostomy. Median duration of follow up was 8.2 years (interquartile range 3.9 – 14.5 years). Patient characteristics, postoperative complications, patient and graft survival rates, as well as short-term and long term biliary outcome parameters were compared between the two groups in a retrospective analysis of a prospectively collected database.

Results Duct-to-duct biliary reconstruction was performed in 45 patients and Roux-en-Y hepatico-jejunostomy in 53 patients. There were no significant differences in patient demographics and general surgical variables between the two groups. Overall patient and graft survival rates were similar in the two groups. The incidence of biliary strictures and biliary leakage within one year after transplantation did not differ among the two groups, however, significantly more patients in the Roux-en-Y group suffered at least one episode of cholangitis within the first year (9% in duct-to-duct versus 25% in Roux-en-Y group; p = 0.04). In addition, Roux-en-Y reconstruction was associated with a significant higher rate of late onset (>1 year post-transplant) non-anastomotic biliary strictures compared to the duct-to-duct group (24% versus 7% at 5 years and 30% versus 7% at 10 years; p = 0.01).

Conclusion The use of duct-to-duct biliary reconstruction in patients with PSC is associated with lower incidences of post-transplant cholangitis and late-onset non-anastomotic biliary strictures, compared to Roux-en-Y hepatico-jejunostomy. If technically and anatomically feasible, duct-to-duct anastomosis should be the preferred technique of biliary reconstruction in patients undergoing OLT for PSC.