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Choledochoduodenostomy continues to be a safe alternative for biliary reconstruction in deceased-donor liver transplantation

  • Ronald Truong
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
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  • Hunter B. Moore
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
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  • Angela Sauaia
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA

    University of Colorado Denver School of Public Health, Department of Health Systems, Management and Policy, 13011 E. 17th Place, Room E-3309, Aurora, CO, 80045, USA
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  • Igal Kam
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
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  • Thomas Pshak
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
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  • Megan Adams
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
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  • Kendra Conzen
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
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  • Michael A. Zimmerman
    Affiliations
    Medical College of Wisconsin, Division of Transplant Surgery, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA
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  • Michael Wachs
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
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  • Thomas Bak
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
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  • James Pomposelli
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
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  • Elizabeth Pomfret
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
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  • Trevor L. Nydam
    Correspondence
    Corresponding author. Department of Surgery, Division of Transplant Surgery, 1635 Aurora Court, 7th Floor, Mail Stop C318, Aurora, CO, 80045, USA.
    Affiliations
    University of Colorado School of Medicine, Division of Transplant Surgery, Department of Surgery, 1635 Aurora Court, 7th Floor, Aurora, CO, 80045, USA
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Published:October 16, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.10.032

      Highlights

      • Choledochoduodenostomy demonstrates outcomes comparable to choledochojejunostomy.
      • Higher odds of cholangitis with choledochojejunostomy versus choledochoduodenostomy.
      • Choledochoduodenostomy provides easier post-operative endoscopic access.
      • Choledochoduodenostomy continues to be a safe alternative to choledochojejunostomy.

      Abstract

      Debate continues as to whether choledochoduodenostomy (CDD) can be used instead of Roux-en-Y choledochojejunostomy (CDJ) when duct-to-duct (DTD) is not an option. We hypothesized that CDD and CDJ had similar rates of complications. All deceased-donor liver transplantations from September 2011 to March 2020 were categorized by biliary reconstruction. Primary outcomes were bleeding, bile leak, anastomotic stricture, and cholangitis. Of the 1,086 patients, 812 (74.8%) received a DTD; 225 (20.7%) received a CDD; and 49 (4.5%) received a CDJ. Cholangitis was significantly higher in CDJ compared to DTD and CDD (26.5% vs 6% vs 13.8%, p < 0.0001). When controlling for significant confounders, CDJ had 10.2 higher odds of cholangitis (95% CI 4.4–23.2) compared to DTD, and 3.3 higher odds compared to CDD (95% CI 1.4–7.8). When compared to DTD, CDJ and CDD had significantly lower odds of stricture. CDD continues to be a safe alternative for biliary reconstruction in deceased-donor liver transplantation.

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