title: The right posterior bile duct anatomy of the donor is important in biliary complications of the recipients after living-donor liver transplantation.
abstract: OBJECTIVE
  To evaluate the influence of the anatomy of the right posterior bile duct (RPBD) of the donor on biliary complications in the recipients after living-donor liver transplantation (LDLT) using right hemi-liver grafts.
  
  
  BACKGROUND
  During living-donor right hepatectomy, the RPBD was often exposed to the dissection plane. We hypothesized that biliary complications after anastomosis were increased in these cases because of potential injury to the RPBD.
  
  
  METHODS
  A total of 169 LDLTs using right hemi-liver grafts, with type I (typical) and type II (trifurcation) anatomy in conventional biliary classification, were retrospectively investigated. The patients were newly classified based on the confluence pattern of the RPBD. The patients were firstly divided into infraportal (IP, n = 12) and supraportal (SP, n = 157) types. SP type was subdivided into 3 groups: type A [ultrashort right bile duct (RBD), n = 20], type B (short RBD, n = 128), and type C (long RBD, n = 9). Type B was further subdivided into B-S (short caudal segment of the RPBD, n = 109) and B-L (long caudal segment of the RPBD, n = 19).
  
  
  RESULTS
  The biliary complication rate was 0% in type IP and type C, 40% in type A, 17.6% in type B-S, and 52.6% in type B-L (P < 0.01). In multivariate analysis, a new grouping of the RBD was a significant risk factor for biliary complications in LDLT.
  
  
  CONCLUSIONS
  The anatomy of the RPBD of the donor influenced the biliary outcome in the recipients. A short RBD and a long caudal segment of the RPBD of the donor were significant risk factors for biliary complications in LDLT.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Min
authors.initials: YM
authors.lastname: Jeon
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Jeong Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Geun
authors.initials: G
authors.lastname: Hong
authors.forename: Youngrok
authors.initials: Y
authors.lastname: Choi
authors.forename: Min-Soo
authors.initials: MS
authors.lastname: Park
authors.forename: Hyeyoung
authors.initials: H
authors.lastname: Kim
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology*; D001652:Bile Ducts / Q000033:anatomy & histology* / Q000601:surgery; D002648:Child; D002779:Cholestasis / Q000209:etiology*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D055815:Young Adult