title: Hilar anatomical variations in living-donor liver transplantation using right-lobe grafts.
abstract: 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.
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tikesurg@yahoo.co.jp
authors: Toru
authors: T
authors: Ikegami
authors: Yuji
authors: Y
authors: Soejima
authors: Akinobu
authors: A
authors: Taketomi
authors: Tomoharu
authors: T
authors: Yoshizumi
authors: Noboru
authors: N
authors: Harada
authors: Hiroto
authors: H
authors: Kayashima
authors: Shinji
authors: S
authors: Itoh
authors: Yo-ichi
authors: Y
authors: Yamashita
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: 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