title: Vascular and biliary anatomy of the right hilar window: its impact on recipient morbidity and mortality for right graft live donor liver transplantation.
abstract: BACKGROUND
  Intrahepatic anatomic variations have been associated with both morbidity and mortality associated with live donor liver transplantation. The aim of our study was to evaluate central hilar and peripheral segmental vascular/biliary anatomy in right graft living donor liver transplantation.
  
  
  METHODS
  From January 2003 to August 2007, three-dimensional (3D) computed tomography (CT) reconstructions and virtual 3D hepatectomies were performed in 71 consecutive right graft live liver donors. A combined two-level classification system addressing the four possible combinations of normal (N) and abnormal (A) central hilar and peripheral features based on both the existing classification and our own classification for portal (portal vein, PV), arterial (hepatic artery, HA) and biliary (bile duct, BD) systems was defined as follows: type I, N/N; type II, N/A; type III, A/N; and type IV, A/A.
  
  
  RESULTS
  A simultaneous normal central hilar and peripheral segmental (N/N) anatomy for each system (PV, HA, BD) was found in <50% of grafts. The highest incidence of complex vascular and biliary reconstructions was observed with grafts having abnormal central (type III) or combined abnormal central/peripheral (type IV) anatomy. Central hilar arterial and biliary anomalies were predictors of morbidity by both univariable and multivariable analyses.
  
  
  CONCLUSIONS
  Our two-level classification and 3D imaging techniques allowed a cautious surgical approach in high-risk cases. Central hilar anatomic variants of the arterial and biliary systems were associated with increased morbidity. Further randomized trials will help determine the precise extent of our observations.
authors: Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany.
authors: Arnold
authors: A
authors: Radtke
authors: George
authors: G
authors: Sgourakis
authors: Georgios C
authors: GC
authors: Sotiropoulos
authors: Ernesto P
authors: EP
authors: Molmenti
authors: Silvio
authors: S
authors: Nadalin
authors: Tobias
authors: T
authors: Schroeder
authors: Fuat
authors: F
authors: Saner
authors: Andrea
authors: A
authors: Schenk
authors: Vito R
authors: VR
authors: Cincinnati
authors: Cristoph E
authors: CE
authors: Broelsch
authors: Hauke
authors: H
authors: Lang
authors: Massimo
authors: M
authors: Malagó
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D009017:Morbidity; D011857:Radiographic Image Interpretation, Computer-Assisted; D014057:Tomography, X-Ray Computed