The Impact of Biliary Reconstruction Methods on Small Partial Liver Grafts

Junichi Yoshikawa, Koichiro Hata, Kojiro Nakamura, Yusuke Okamura, Shinji Uemoto

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background. Graft recipient weight ratios are lower in adult-to-adult living-donor liver transplantation than in adult-to-adult deceased-donor liver transplantation. Rapid liver regeneration is essential for increased recipient survival rates in adult-to-adult living-donor liver transplantation. However, the influence of biliary reconstruction methods, including choledocho-choledochostomy and choledocho-jejunostomy, on small partial liver grafts remains unknown. Herein, we investigate the impact of these biliary reconstruction methods on small partial liver grafts. Methods. Male Lewis rats underwent isogenic arterialized 30% partial liver transplantation with small partial grafts, either via choledocho-jejunostomy or choledocho-choledochostomy. Results. The 7-day survival rates of the choledocho-choledochostomy and choledocho-jejunostomy groups were 100% and 50%, respectively (P = 0.011). Choledocho-jejunostomy provoked reflux cholangitis, as confirmed by neutrophil infiltration around the bile ducts; suppressed and delayed liver regeneration in grafts, as confirmed by significant increases in intrahepatic interleukin-1β level, significant decreases in the graft weight increase ratios, hepatocyte proliferation, and intrahepatic mRNA expression of vascular endothelial growth factor; and induced graft dysfunction, as confirmed by the presence of massive ascites, significantly decreased bile production, and prolonged elevation of total bilirubin, aspartate aminotransferase, and alanine aminotransferase. Conclusions. Choledocho-jejunostomy predisposed grafts to cholangitis, impaired liver regeneration, and aggravated animal survival, suggesting that choledocho-choledochostomy may be preferable over choledocho-jejunostomy in adult-to-adult living-donor liver transplantation.

Original languageEnglish
Article numbere523
JournalTransplantation Direct
Publication statusAccepted/In press - 2020
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Transplantation


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