Impact of bile duct number and anastomosis technique on postoperative morbidity and mortality in living and deceased donor liver transplantation

Objective: This study aims to retrospectively examine the relationship between graft bile duct number (single or multiple) and biliary anastomosis technique (duct-to-duct or Roux-en-Y hepaticojejunostomy) with postoperative morbidity and mortality in living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) patients. Material and Methods: A retrospective cohort study was conducted on 244 patients who underwent LDLT and DDLT at Ankara Güven Hospital Liver Transplantation Center between January 2013 and January 2025. Patient data including demographic characteristics, preoperative parameters (MELD score, underlying liver disease), surgical variables (bile duct number, anastomosis type, graft type, operation time), and postoperative outcomes were collected systematically. Bile duct anatomy was classified as single or multiple ducts, and anastomosis techniques were categorized as duct-to-duct or Roux-en-Y. Biliary complications were graded according to the International Liver Transplant Society consensus classification and Clavien-Dindo system. Statistical analyses were performed using SPSS 27.0, employing independent-samples t-tests, Mann-Whitney U tests, and chi-square tests. Results: The mean patient age was 57.8±11.5 years with mean body mass index (BMI) of 27.62±5.67 kg/m². The cohort comprised 70.49% males and 29.51% females. Significant gender distribution differences were observed between groups, with higher male ratio in the duct-to-duct group (75.94%) compared to Roux-en-Y group (63.96%; p=0.041). Diabetes mellitus prevalence was notably higher in the Roux-en-Y group (46.85%) versus duct-to-duct group (34.59%; p=0.052). No significant differences were found in age, BMI, or blood group distribution between anastomosis techniques. Conclusion: Preliminary findings suggest demographic and comorbidity variations between anastomosis technique groups, indicating the need for individualized surgical planning in LDLT and DDLT based on bile duct anatomy and patient characteristics.