DUCT-TO-DUCT BILIARY RECONSTRUCTION FOLLOWING LIVER-TRANSPLANTATION FOR PRIMARY SCLEROSING CHOLANGITIS

The biliary complications in patients undergoing biliary reconstructio n by duct-to-duct (D-D) anastomosis or with a Roux-en-Y loop (RL) at t he time of liver transplantation for primary sclerosing cholangitis (P SC, 16 D-D, 10 RL) or primary biliary cirrhosis (PBC, 31 D-D, 1 RL) we re 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, respectiv ely (P = NS). Four intrahepatic biliary abnormalities developed in the PSC group. Duct-to-duct anastomosis did not significantly increase th e risk of stricture formation or bile leaks in PSC patients compared t o PBC patients. We conclude that duct-to-duct biliary reconstruction f ollowing liver transplantation for PSC is satisfactory unless the dist al common bile duct is strictured.