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Invited Commentary
February 13, 2019

The Realities of Liver Transplantation and Biliary Anastomosis—Heroes, Heroics, Heels, and Healing

Author Affiliations
  • 1Division of Transplant Surgery, Department of Surgery, University of California, Davis School of Medicine, Sacramento
JAMA Surg. Published online February 13, 2019. doi:10.1001/jamasurg.2018.5538

In the Trojan war, Achilles was the strongest and most capable of the Greek Heroes. Held by a single heel, his mother bathed him as an infant in the River Styx to make him all but immortal. Her hand left a seemingly trivial area unexposed, and thus became the vulnerability that led to his demise. In the battle for health, the results of liver transplant are nothing less than heroic. The final and seemingly most trivial step of completing a transplant is the biliary anastomosis; yet sadly, it often remains one of the most problematic. Indeed, since the earliest published reports, it has been termed the procedure’s Achilles’ Heel.1

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