Prolonged cold ischemic time is a risk factor for biliary strictures in duct-to-duct biliary reconstruction in living donor liver transplantation

BACKGROUND.: Duct-to-duct (DD) anastomosis is an accepted procedure for biliary reconstruction in living donor liver transplantation (LDLT). However, biliary complication rates in LDLT recipients have been reported to be as high as 20% to 30% or more. In this study, we examined various potential risk factors for biliary stricture (BS) that occurs in the context of DD reconstruction in a single-active transplant center. METHODS.: Enrolled in this study were adults who underwent their first LDLT with DD reconstruction between August 2002 and May 2007 (n=283). BSs were defined as anastomotic strictures that required interventions or operative procedures to be corrected. We reviewed retrospectively the medical records of recipients, including medical history, surgical procedures, and progress, and analyzed risk factors of BS with the Kaplan-Meier method. RESULTS.: BS occurred in 58 of the 283 recipients (20.5%). The mean follow-up period was 24.4 months posttransplant (SD=16.5). The univariate analysis revealed that recipient age (P=0.032), bile duct size (P=0.003), biliary reconstruction surgeon (P=0.023), perfusion solution (P=0.001), cold ischemic time (CIT) (P<0.001), and biliary leakage history (P<0.001) were significant risk factors. In the multivariable analysis, CIT (P=0.001), biliary leakage history (P=0.002), bile duct size (P=0.021), and recipient age (P=0.036) were significant risk factors for BS. And, a CIT cutoff value of 71 min was calculated using the minimum P value approach with correction by the Miller and Siegmund method (P=0.0186). CONCLUSIONS.: In this study, prolonged CIT is identified as a risk factor for BS in DD biliary reconstruction in LDLT.