Evaluation of donor vasculobiliary anatomic variations in liver graft procurements
Accepted 1 June 2009. published online 02 November 2009.
Background
The relationship among bile duct (BD), portal vein (PV), and/or hepatic artery (HA) anatomy is controversial, but no investigation has previously compared left and right liver graft transplantation in terms of variant vasculobiliary anatomy. Therefore, in this study, we explored whether variant BD anatomy can be predicted from portal PV or HA anatomy, and we compared left and right liver graft transplantation from the standpoint of vasculobiliary reconstruction.
Methods
The associations between BD and PV and/or HA anatomies were evaluated in 361 donors. The number of vasculobiliary stumps in each graft, the number of stumps reconstructed, and the clinical outcomes were then compared between 133 left and 154 right liver grafts.
Results
Variant BD was more frequently associated with variant than with normal PV anatomy (57.0% vs 28.4%). No correlation was found between variant BD and variant HA anatomy. Multiple PVs (left versus right, 0% vs 5.8%) and BDs (40.6% vs 59.7%) appeared more frequently in right liver grafts, and all stumps were reconstructed. Although multiple HAs appeared more frequently in left liver grafts (47.4% vs 1.3%), multiple stumps were rarely anastomosed. The incidence of HA/PV thrombosis or biliary strictures was comparable between left and right liver grafts.
Conclusion
Variant PV, but not variant HA, anatomies frequently accompany variant BD anatomy. Vasculobiliary variations sometimes lead to technical complexities, but this is more problematic in right liver graft transplantation. Left liver grafts are more feasible for vasculo-biliary reconstruction.
Department of Hepato-Biliary-Pancreatic Surgery and Artificial Organ Transplantation, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Reprint requests: Hiroshi Imamura, MD, PhD, Department of Hepatobiliary-Pancreatic Surgery, Juntendo School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
ABSTRACT