Choledochoduodenostomy continues to be a safe alternative for biliary reconstruction in deceased-donor liver transplantation - 08/12/22

Doi : 10.1016/j.amjsurg.2022.10.032

Ronald Truong ^a, Hunter B. Moore ^a, Angela Sauaia ^a,^b, Igal Kam ^a, Thomas Pshak ^a, Megan Adams ^a, Kendra Conzen ^a, Michael A. Zimmerman ^c, Michael Wachs ^a, Thomas Bak ^a, James Pomposelli ^a, Elizabeth Pomfret ^a, Trevor L. Nydam ^a,^⁎
^a University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
^b University of Colorado Denver School of Public Health, Department of Health Systems, Management and Policy, 13011 E. 17th Place, Room E-3309, Aurora, CO, 80045, USA
^c Medical College of Wisconsin, Division of Transplant Surgery, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA

^∗Corresponding author. Department of Surgery, Division of Transplant Surgery, 1635 Aurora Court, 7th Floor, Mail Stop C318, Aurora, CO, 80045, USA.Department of SurgeryDivision of Transplant Surgery1635 Aurora Court7th FloorMail Stop C318AuroraCO80045USA

Abstract

Debate continues as to whether choledochoduodenostomy (CDD) can be used instead of Roux-en-Y choledochojejunostomy (CDJ) when duct-to-duct (DTD) is not an option. We hypothesized that CDD and CDJ had similar rates of complications. All deceased-donor liver transplantations from September 2011 to March 2020 were categorized by biliary reconstruction. Primary outcomes were bleeding, bile leak, anastomotic stricture, and cholangitis. Of the 1,086 patients, 812 (74.8%) received a DTD; 225 (20.7%) received a CDD; and 49 (4.5%) received a CDJ. Cholangitis was significantly higher in CDJ compared to DTD and CDD (26.5% vs 6% vs 13.8%, p < 0.0001). When controlling for significant confounders, CDJ had 10.2 higher odds of cholangitis (95% CI 4.4–23.2) compared to DTD, and 3.3 higher odds compared to CDD (95% CI 1.4–7.8). When compared to DTD, CDJ and CDD had significantly lower odds of stricture. CDD continues to be a safe alternative for biliary reconstruction in deceased-donor liver transplantation.

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Highlights

•	Choledochoduodenostomy demonstrates outcomes comparable to choledochojejunostomy.
•	Higher odds of cholangitis with choledochojejunostomy versus choledochoduodenostomy.
•	Choledochoduodenostomy provides easier post-operative endoscopic access.
•	Choledochoduodenostomy continues to be a safe alternative to choledochojejunostomy.

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Keywords : Choledochoduodenostomy, Choledochojejunostomy, Liver transplantation, Biliary anastomosis, Duct-to-duct

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Univariate analysis ()

Multivariate analysis CDJ vs DTD and CDD ()

Multivariate analysis CDD vs DTD ()

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Vol 224 - N° 6

P. 1398-1402 - décembre 2022 Retour au numéro

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Choledochoduodenostomy continues to be a safe alternative for biliary reconstruction in deceased-donor liver transplantation - 08/12/22

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