Hilar anatomical variations in living-donor liver transplantation using right-lobe grafts.
BACKGROUND
Living-donor liver transplantation using a right-lobe graft has increased the frequency of hilar anatomical variations despite its advantage of a larger graft volume.


METHODS
Sixty-seven living-donor liver transplantations using right-lobe grafts are reviewed, regarding the surgical anatomy of hilar vascular and biliary systems.


RESULTS
The portal anatomy was classified into four types. The incidence of double portal vein was 6.0% (n = 4), and for such cases a unified orifice (n = 1) or a Y-graft (n = 3) was used for reconstruction. The arterial system was classified into five types. The incidence of arterial complications was 6.0% (n = 4), all of which occurred in cases where the graft artery was connected to the recipient's right hepatic artery. The biliary system was classified into four types. The incidence of a double bile duct was 7.5% (n = 5), and that of a unified one was 29.8% (n = 20). Hepaticojejunostomy was more prone to biliary sepsis (25.0%) and bile leakage (18.8%) than duct-to-duct connection (0 and 2%, respectively).


CONCLUSIONS
Hilar anatomical variations in right-lobe living-donor liver transplantation could be managed after preoperative detailed evaluation of the graft and intraoperative appropriate surgical decision and techniques.
Ikegami
Toru
T
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tikesurg@yahoo.co.jp
Soejima
Yuji
Y
Taketomi
Akinobu
A
Yoshizumi
Tomoharu
T
Harada
Noboru
N
Kayashima
Hiroto
H
Itoh
Shinji
S
Yamashita
Yo-ichi
Y
Maehara
Yoshihiko
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D001158:Arteries / Q000033:anatomy & histology; D001652:Bile Ducts / Q000033:anatomy & histology; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008099:Liver / Q000033:anatomy & histology*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000033:anatomy & histology; D011169:Portal Vein / Q000033:anatomy & histology; D011183:Postoperative Complications; D016896:Treatment Outcome