Duct-to-duct biliary reconstruction in liver transplantation for primary sclerosing cholangitis is associated with less biliary complications, compared with Roux-en-Y hepatico-jejunostomy

Background There is no consensus on the preferred type of biliary reconstruction in patients undergoing orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC). Aim of this study was to compare long-term outcome after OLT for PSC using either duct-to-duct anastomosis or Roux-en-Y hepatico-jejunostomy for biliary reconstruction. Methods In a consecutive series of 98 adult patients undergoing OLT for PSC, 45 underwent duct-toduct and 53 a Roux-en-Y biliary reconstruction. Median follow up was 8.2 years (interquartile range 3.9 – 14.5 years). Outcome was compared between the two groups. Results There were no significant differences in patient demographics and general surgical variables between groups. Overall patient and graft survival rates were similar in the two groups. The incidence of biliary strictures and biliary leakage within one year after transplantation did not differ among the two groups. However, significantly more patients in the Roux-en-Y group suffered at least one episode of cholangitis within the first year (9% in duct-toduct versus 25% in Roux-en-Y group; p=0.04). In addition, Roux-en-Y reconstruction was associated with a significantly higher rate of late onset (>1 year posttransplant) nonanastomotic biliary strictures compared to duct-toduct reconstruction (24% versus 7%, at 5 years and 30% versus 7% at 10 years; p=0.01). Conclusion Duct-to-duct biliary reconstruction in patients with PSC is associated with lower incidences of posttransplant cholangitis and late-onset non-anastomotic biliary strictures, compared with Roux-en-Y hepatico-jejunostomy. If technically and anatomically feasible, ductto-duct anastomosis should be the preferred technique of biliary reconstruction in patients undergoing OLT for PSC. D uc t-t odu ct b ili ar y re co ns tr uc ti on in li ve r tr an sp la nt at io n fo r pr im ar y sc le ro si ng c ho la ng it is is a ss oc ia te d w it h le ss b ili ar y co m pl ic at io ns , co m pa re d w it h Ro ux -e nY h ep at ic oje ju no st om y.