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The effect of intraductal transanastomotic stent in reducing biliary complication after duct-to-duct biliary reconstruction in living donor liver transplantation: Single center experience.

Introduction
Despite of the innovations in surgical and postoperative surgical treatment of donors and recipients, biliary complication is still considered to be a technical "Achilles' heel" of living donor liver transplantation (LDLT) due to the high incidence, requiring long-term interventional treatment, and potential risk for graft failure. The purpose of this study was to evaluate the effect of intraductal transanastomotic stent in reducing biliary complications after LDLT.


Methods
From August 2015 to February 2020, 201 adult LDLTs using right liver were enrolled. The intraductal transanastomotic stent was a silicone tube of various diameters considering the duct size. By dividing biliary complication into bile leakage and stricture, the risk factor and effect of stent were analyzed.


Results
In all patients with LDLT, biliary complications occurred in 54 (26.9%) patients and anastomosis site leakage occurred in 9 (9.5%) patients. Of the 201 patients, non-stent group was 101 (50.2%) patients and stent group was 100 (49.8%) patients. Anastomosis site leakage was higher in the non-stent group (n = 15, 14.9%) than in the stent group (n = 4, 4.0%, p = 0.005). Biliary stricture was also higher in the non-stent group (n = 30, 29.7%) than in the stent group (n = 17, 17.0%, p = 0.03). In multivariate analysis, hepatic artery thrombosis (p < 0.001) and intraductal stent (p = 0.01).


Conclusions
Intraductal transanastomotic stent can reduces biliary complications including anastomosis leakage and stricture. Further large-scale analyses of clinical data or randomized controlled trial are required to support this study.