Living donor liver transplantation in adults: vascular variants important in surgical planning for donors and recipients.
OBJECTIVE
The purpose of our study was to explore the frequency with which surgically important hepatic vascular variants occur independently as well as in genetically related adult candidates for donation or receipt of a liver transplant.


METHODS
We conducted a retrospective study of 107 adult living donor liver transplant candidates. From this pool of candidates, 50 sets of close relatives were selected to undergo transplantation. As part of the preoperative evaluation, all underwent multidetector CT angiography for evaluation of arterial and venous anatomy. Nonionic IV contrast material (180 mL) was given at a rate of 5 mL/sec, and collimations of 1.25 and 2.50 mm were used for true arterial and portal hepatic venous phase scanning, respectively. Image processing included three-dimensional volume renderings and multiplanar reformations. Two radiologists assessed the prevalence of vascular variants that were important for surgical planning and execution.


RESULTS
We identified surgically important hepatic vascular variants in 70 (65%) of the 107 patients. A total of 129 variants were identified, of which 27 were important surgical considerations for recipients, 37 were important for donors, and 65 were important for both recipients (19 variants) and donors (46 variants). Of the 50 pairs of close relatives, 10 (20%) of the pairs were found to have the same hepatic vascular variant or one that was similar. However, when the pairs were set randomly, with no genetically related pairs included, similar variants were noted in 11 pairs (22%). The most common hepatic arterial variant in all candidates was an accessory right or left hepatic artery. The most common hepatic venous variant was an accessory right inferior hepatic vein.


CONCLUSIONS
We observed a high prevalence of surgically important vascular variants in living adult candidates for living liver transplant donation and receipt. Because of the frequent occurrence, similar variants are to be expected among these sets of patients, regardless of whether they are closely related.
Erbay
Nazli
N
Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA.
Raptopoulos
Vassilios
V
Pomfret
Elizabeth A
EA
Kamel
Ihab R
IR
Kruskal
Jonathan B
JB
D000328:Adult; D000792:Angiography; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed