title: Evaluation of donor vasculobiliary anatomic variations in liver graft procurements.
abstract: BACKGROUND
  The relationship among bile duct (BD), portal vein (PV), and/or hepatic artery (HA) anatomy is controversial, but no investigation has previously compared left and right liver graft transplantation in terms of variant vasculobiliary anatomy. Therefore, in this study, we explored whether variant BD anatomy can be predicted from portal PV or HA anatomy, and we compared left and right liver graft transplantation from the standpoint of vasculobiliary reconstruction.
  
  
  METHODS
  The associations between BD and PV and/or HA anatomies were evaluated in 361 donors. The number of vasculobiliary stumps in each graft, the number of stumps reconstructed, and the clinical outcomes were then compared between 133 left and 154 right liver grafts.
  
  
  RESULTS
  Variant BD was more frequently associated with variant than with normal PV anatomy (57.0% vs 28.4%). No correlation was found between variant BD and variant HA anatomy. Multiple PVs (left versus right, 0% vs 5.8%) and BDs (40.6% vs 59.7%) appeared more frequently in right liver grafts, and all stumps were reconstructed. Although multiple HAs appeared more frequently in left liver grafts (47.4% vs 1.3%), multiple stumps were rarely anastomosed. The incidence of HA/PV thrombosis or biliary strictures was comparable between left and right liver grafts.
  
  
  CONCLUSIONS
  Variant PV, but not variant HA, anatomies frequently accompany variant BD anatomy. Vasculobiliary variations sometimes lead to technical complexities, but this is more problematic in right liver graft transplantation. Left liver grafts are more feasible for vasculo-biliary reconstruction.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery and Artificial Organ Transplantation, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Kishi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Keiji
authors.initials: K
authors.lastname: Sano
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D001652:Bile Ducts / Q000033:anatomy & histology*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006499:Hepatic Artery / Q000033:anatomy & histology*; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000033:anatomy & histology*