A single-center experience with biliary reconstruction in retransplantation: duct-to-duct or Roux-en-Y choledochojejunostomy

Abstract

Retransplantation is the only therapy for patients who have a failing liver graft, and it can be technically challenging. Although duct-to-duct (DD) biliary reconstruction is considered standard in deceased donor orthotopic whole organ liver transplantation, Roux-en-Y (RY) choledochojejunostomy is preferred by most for biliary reconstruction in retransplantation. We performed a retrospective review of 128 patients who underwent retransplantation after a first transplant with DD biliary construction. Of these 128 patients, 83 had DD biliary reconstructions, and 45 had RY biliary reconstructions. Log-rank tests were used to compare the complication rates between the DD and RY groups, whereas multivariate Cox proportional hazards models were used to compare patient and graft survival between the groups. The median Model for End-Stage Liver Disease score at retransplantation was significantly higher in the DD group (27 versus 21, P = 0.005). The median length of follow-up was 3.3 years. The biliary complication rates were 7% and 11% in the DD group and 10% and 10% in the RY group 30 days and 1 year after retransplantation, respectively (P = 0.73). The rates of primary graft nonfunction complications, hepatic artery thrombosis complications, and reoperation did not differ significantly between groups (all P ≥ 0.37). In comparison with RY reconstruction, there was no evidence of a difference in patient survival (relative risk = 0.79, P = 0.47) or graft survival (relative risk = 0.94, P = 0.85) for patients with DD reconstruction in multivariate analysis. In conclusion, our results provide evidence that DD biliary reconstruction is feasible in liver retransplantation without increased rates of biliary complications or compromised patient and graft survival. Further studies with larger sample sizes are needed.