Duct-to-duct biliary reconstruction following liver transplantation for primary sclerosing cholangitis

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Abstract
The biliary complications in patients undergoing biliary reconstruction by duct‐to‐duct (D‐D) anastomosis or with a Roux‐en‐Y loop (RL) at the time of liver transplantation for primary sclerosing cholangitis (PSC, 16 D‐D, 10 RL) or primary biliary cirrhosis (PBC, 31 D‐D, 1 RL) were reviewed and compared. Patients were followed up for a mean period of 32 months. Extrahepatic biliary strictures occurred in 18.7%, 10% and 9.7 % of DD‐PSC, RL‐PSC and DD‐PBC patients, respectively, leaks in 6.2%, 20% and 6.4% DD‐PSC, RL‐PSC and DD‐PBC patients, respectively (P= NS). Four intrahepatic biliary abnormalities developed in the PSC group. Duct‐to‐duct anastomosis did not significantly increase the risk of stricture formation or bile leaks in PSC patients compared to PBC patients. We conclude that duct‐to‐duct biliary reconstruction following liver transplantation for PSC is satisfactory unless the distal common bile duct is strictured.