title: Living donor liver hilar variations: surgical approaches and implications.
abstract: BACKGROUND
  Varied vascular and biliary anatomies are common in the liver. Living donor hepatectomy requires precise recognition of the hilar anatomy. This study was undertaken to study donor vascular and biliary tract variations, surgical approaches and implications in living liver transplant patients.
  
  
  METHODS
  Two hundred living donor liver transplantations were performed at our institution between 2004 and 2009. All donors were evaluated by volumetric computerized tomography (CT), CT angiography and magnetic resonance cholangiography in the preoperative period. Intraoperative ultrasonography and cholangiography were carried out. Arterial, portal and biliary anatomies were classified according to the Michels, Cheng and Huang criteria.
  
  
  RESULTS
  Classical hepatic arterial anatomy was observed in 129 (64.5%) of the 200 donors. Fifteen percent of the donors had variation in the portal vein. Normal biliary anatomy was found in 126 (63%) donors, and biliary tract variation in 70% of donors with portal vein variations. In recipients with single duct biliary anastomosis, 16 (14.4%) developed biliary leak, and 9 (8.1%) developed biliary stricture; however more than one biliary anastomosis increased recipient biliary complications. Donor vascular variations did not increase recipient vascular complications. Variant anatomy was not associated with an increase in donor morbidity.
  
  
  CONCLUSIONS
  Living donor liver transplantation provides information about variant hilar anatomy. The success of the procedure depends on a careful approach to anatomical variations. When the deceased donor supply is inadequate, living donor transplantation is a life-saving alternative and is safe for the donor and recipient, even if the donor has variant hilar anatomy.
authors.affiliation: Hepatobiliary and Organ Transplant Center, Florence Nightingale Hospital, Istanbul, Turkey. onuryaprak@hotmail.com
authors.forename: Onur
authors.initials: O
authors.lastname: Yaprak
authors.forename: Tolga
authors.initials: T
authors.lastname: Demirbas
authors.forename: Cihan
authors.initials: C
authors.lastname: Duran
authors.forename: Murat
authors.initials: M
authors.lastname: Dayangac
authors.forename: Murat
authors.initials: M
authors.lastname: Akyildiz
authors.forename: Yaman
authors.initials: Y
authors.lastname: Tokat
authors.forename: Yildiray
authors.initials: Y
authors.lastname: Yuzer
mesh_terms: D000293:Adolescent; D000328:Adult; D001659:Biliary Tract / Q000002:abnormalities; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006499:Hepatic Artery / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D008099:Liver / Q000002:abnormalities / Q000098:blood supply / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011169:Portal Vein / Q000002:abnormalities / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult