164 Comparable Long-Term Outcomes of Duct-to-Duct vs. Roux-en-Y Hepaticojejunostomy in Liver Transplantation for Primary Sclerosing Cholangitis: A Contemporary Analysis

Abstract Background Biliary reconstruction during liver transplantation (LT) for primary sclerosing cholangitis (PSC) remains debated. A 2015 meta-analysis of 10 studies (1996-2014), found similar biliary stricture (BS) rates for duct-to-duct (DD) and Roux-en-Y hepaticojejunostomy (RYH), but higher post-transplant cholangitis in RYH. This study evaluates DD versus RYH outcomes in a contemporary PSC cohort from a high-volume centre. Methods Retrospective review of all primary PSC transplants at King's College Hospital between 2014-2023. Results 169 PSCs were transplanted over 10 year; after excluding 7 regrafts and 12 missing data, 150 were analysed (DD: 19, RYH: 131). The two groups were comparable for recipient age, gender, UKELD, but DCD grafts were more common in DD group (47% vs. 16%; p=0.004). Three RYH patients needed Whipple’s post-LT. There was no difference between DD vs. RYH with respect to: bile leak (5.3% vs. 2.3%; p=0.421), anastomotic BS (15.8% vs. 9.2%; p=0.408), non-anastomotic BS (5.3% vs. 12.2%; p=0.698), reoperation for biliary issues (0% vs. 3.0%; p=1.000), need for ERCP or PTC (15.7% vs. 13.0%; p=0.720), PSC recurrence (10.5% vs. 13.7%;p=1.000), or need for retransplantation (15.8% vs. 9.9%; p=0.429). There was also no difference in length of ITU or hospital stay, and graft and patient survival between the two groups. Conclusion With a median follow-up of 5 years, this large cohort study shows no difference in outcomes between the DD and RYH in PSC. We conclude that DD maintains standard endoscopic access without increasing biliary complications despite more DCD grafts, and hence should be considered when anatomically feasible.