- 作者：Arvinder Singh Soin ; Vinay Kumaran ; Amit Nath Rastogi ; Ravi Mohanka ; Naimish Mehta ; Sanjiv Saigal ; Neeraj Saraf ; Neelam Mohan ; Samiran Nundy
- 刊名：Journal of the American College of Surgeons
- 出版年：2010
- 出版时间：July 2010
- 年：2010
- 卷：211
- 期：1
- 页码：24-32
- 全文大小：706 K
Background
Biliary complications (BCs) are a major cause of morbidity and mortality after living donor liver transplantation (LDLT). They occur because the graft hepatic ducts are often small, thin walled, multiple, and may become ischemic during transection.Study Design
Of the 460 LDLTs done at our center before November 2009, the first 402 partial liver grafts had at least 3 months of follow-up. In the first 158, conventional hepatic duct isolation was used in the donor (group C). In the last 244 cases, the complete hilar plate and Glissonian sheath approach (HPGS) was used (group H). We compared the incidence and outcomes of BCs in the 2 groups.
Results
The rate of BC was significantly lower in group H (5.3 % ) than in group C (15.8 % , p = 0.000). The incidence of early (within 3 months of transplant) BCs was similarly significantly lower in group H (3.3 % ) than in group C (13.2 % , P=0.000). The incidence of late BCs in the 145 patients in group H who had completed at least 12 months of follow-up was 2.8 % .The proportion of BCs needing surgical correction was much higher in group C (44 % ) than in group H (7.7 % , p = 0.022).
Conclusions
By providing a graft with a well-vascularized hepatic duct or ducts with a sheath of supporting tissue that holds sutures well, the HPGS approach minimizes the incidence and severity of BCs in LDLT.