Living donor liver hilar variations: Surgical approaches and implications

Onur Yaprak, Tolga Demirbas, Cihan Duran, Murat Dayangac, Murat Akyildiz, Yaman Tokat, Yildiray Yuzer

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND: Varied vascular and biliary anatomies are common in the liver. Living donor hepatectomy requires precise recognition of the hilar anatomy. This study was undertaken to study donor vascular and biliary tract variations, surgical approaches and implications in living liver transplant patients. METHODS: Two hundred living donor liver transplantations were performed at our institution between 2004 and 2009. All donors were evaluated by volumetric computerized tomography (CT), CT angiography and magnetic resonance cholangiography in the preoperative period. Intraoperative ultrasonography and cholangiography were carried out. Arterial, portal and biliary anatomies were classified according to the Michels, Cheng and Huang criteria. RESULTS: Classical hepatic arterial anatomy was observed in 129 (64.5%) of the 200 donors. Fifteen percent of the donors had variation in the portal vein. Normal biliary anatomy was found in 126 (63%) donors, and biliary tract variation in 70% of donors with portal vein variations. In recipients with single duct biliary anastomosis, 16 (14.4%) developed biliary leak, and 9 (8.1%) developed biliary stricture; however more than one biliary anastomosis increased recipient biliary complications. Donor vascular variations did not increase recipient vascular complications. Variant anatomy was not associated with an increase in donor morbidity. CONCLUSIONS: Living donor liver transplantation provides information about variant hilar anatomy. The success of the procedure depends on a careful approach to anatomical variations. When the deceased donor supply is inadequate, living donor transplantation is a life-saving alternative and is safe for the donor and recipient, even if the donor has variant hilar anatomy.

Original languageEnglish (US)
Pages (from-to)474-479
Number of pages6
JournalHepatobiliary and Pancreatic Diseases International
Volume10
Issue number5
DOIs
StatePublished - Oct 2011
Externally publishedYes

Fingerprint

Living Donors
Tissue Donors
Anatomy
Liver
Blood Vessels
Cholangiography
Biliary Tract
Portal Vein
Liver Transplantation
Tomography
Preoperative Period
Magnetic Resonance Angiography
Hepatectomy
Ultrasonography
Pathologic Constriction
Transplantation
Morbidity
Transplants

Keywords

  • Anatomical variation
  • Liver transplantation
  • Living donor

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Living donor liver hilar variations : Surgical approaches and implications. / Yaprak, Onur; Demirbas, Tolga; Duran, Cihan; Dayangac, Murat; Akyildiz, Murat; Tokat, Yaman; Yuzer, Yildiray.

In: Hepatobiliary and Pancreatic Diseases International, Vol. 10, No. 5, 10.2011, p. 474-479.

Research output: Contribution to journalArticle

Yaprak, Onur ; Demirbas, Tolga ; Duran, Cihan ; Dayangac, Murat ; Akyildiz, Murat ; Tokat, Yaman ; Yuzer, Yildiray. / Living donor liver hilar variations : Surgical approaches and implications. In: Hepatobiliary and Pancreatic Diseases International. 2011 ; Vol. 10, No. 5. pp. 474-479.
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N2 - BACKGROUND: Varied vascular and biliary anatomies are common in the liver. Living donor hepatectomy requires precise recognition of the hilar anatomy. This study was undertaken to study donor vascular and biliary tract variations, surgical approaches and implications in living liver transplant patients. METHODS: Two hundred living donor liver transplantations were performed at our institution between 2004 and 2009. All donors were evaluated by volumetric computerized tomography (CT), CT angiography and magnetic resonance cholangiography in the preoperative period. Intraoperative ultrasonography and cholangiography were carried out. Arterial, portal and biliary anatomies were classified according to the Michels, Cheng and Huang criteria. RESULTS: Classical hepatic arterial anatomy was observed in 129 (64.5%) of the 200 donors. Fifteen percent of the donors had variation in the portal vein. Normal biliary anatomy was found in 126 (63%) donors, and biliary tract variation in 70% of donors with portal vein variations. In recipients with single duct biliary anastomosis, 16 (14.4%) developed biliary leak, and 9 (8.1%) developed biliary stricture; however more than one biliary anastomosis increased recipient biliary complications. Donor vascular variations did not increase recipient vascular complications. Variant anatomy was not associated with an increase in donor morbidity. CONCLUSIONS: Living donor liver transplantation provides information about variant hilar anatomy. The success of the procedure depends on a careful approach to anatomical variations. When the deceased donor supply is inadequate, living donor transplantation is a life-saving alternative and is safe for the donor and recipient, even if the donor has variant hilar anatomy.

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