Liver transplant donor candidates: Associations between vascular and biliary anatomic variants

Abstract

Our objective was to investigate the coexistence of vascular and biliary anatomic variants, the latter of which are known to increase the risk of biliary complications in living liver donor transplantation. A total of 108 consecutive liver donor candidates were examined by magnetic resonance (MR) imaging that included 2 MR cholangiography methods, T2-weighted MR cholangiography and mangofodipir-enhanced T1-weighted three-dimensional (3D) MR cholangiography, as well as gadoliniumenhanced MR angiography and venography of the liver. Images were interpreted by at least 2 investigators in consensus for definition of hepatic arterial, portal venous, and biliary anatomy. A subset of 51 subjects underwent laparotomy for right hepatectomy. Of the 108 subjects examined, 50 (46%) demonstrated normal hepatic artery, portal vein, and biliary anatomy. Variants of the hepatic artery were found in 27 of 108 (25%) subjects, of the portal vein in 12 of 108 (11%) subjects, and of the bile ducts in 30 of 108 (28%) subjects. Of the 27 subjects with hepatic arterial variants, 8 (30%) also had variant biliary anatomy. The association between hepatic arterial variants and biliary variants was not statistically significant (P > .5). However, of the 12 subjects with portal vein variants, 7 (58%) had biliary variants, and in 6 of 7 cases, the right posterior hepatic duct was anomalous. By chisquare analysis, the association between portal venous and biliary variants was significant (P ‫؍‬ .012). In conclusion, over half of subjects with portal vein variants were found to have anomalous biliary anatomy, which always involved the hepatic ducts of the right lobe. The association between portal venous and biliary variants is statistically significant, while there is no significant association between hepatic arterial and biliary variants. (Liver

Correlation Between Portal Vein Anatomy and Bile Duct Variation in 407 Living Liver Donors

“…These rates are consistent with the previously reported rates of 8.3-30% in living liver donors (2,3,13,14,16,17), 16.8-46% in patients undergoing liver resection (1), and 28-44% in radiological imaging studies (12,18). We also found that donors with a variant PV were more likely to have a variant BD than were donors with a normal PV (p < 0.0001), which is also consistent with previous reports (1,2,12,14,19). Furthermore, 61% of donors with a variant PV had a variant BD, but 80% of donors with a normal PV did not, implying that the presence of PV abnormalities might help to predict whether the BD is anatomically normal or not.…”

“…Previous several studies have demonstrated an association between BD and HA or PV anatomy; however, the findings were controversial (1,2,(12)(13)(14). There are also very few reports describing the spatial relationship between the BD and PV, including the infraportal or supraportal course of the right posterior BD (RPBD).…”

Expectations from imaging for pre-transplant evaluation of living donor liver transplantation

“…The limitations of MR-specific artifacts (e.g., pseudo-obstruction of the common hepatic duct caused by pulsatile vascular compression by the right hepatic artery) do not exist for CTCh [50] . Variations in biliary anatomy have a statistically significant association with variations in portal venous anatomy [51] . Biliary tract complications after liver transplantation have been reported in 10%-25% of cases, proving fatal in up to 10% of complicated cases [52,53] .…”

Ultrasound examination of the liver: Normal vascular anatomy

“…Ultrasonography is the only possible solution although the information it furnishes is inferior. The sonographer performing the examination must have an excellent knowledge of the hepatic vascular anatomy as it appears on sonography [4] (Fig. 1).…”