Predicting Biliary Complications in Right Lobe Liver Transplant Recipients according to Distance between Donor's Bile Duct and Corresponding Hepatic Artery

Abstract

To retrospectively determine whether biliary complications in recipients of living-donor right lobe liver grafts can be predicted at pretransplantation donor computed tomography (CT). The human research committee approved this study. The requirement for informed consent was waived. Multi-detector row CT cholangiography and CT angiography were performed in 44 consecutive right lobe liver donors (25 men, 19 women; mean age, 37 years). When CT cholangiography in the donor demonstrated the right biliary anatomy (conventional or variant), the shortest distance between the right main (or second-order) hepatic artery and the corresponding right main (or second-order) bile duct was measured and compared with posttransplantation biliary complications in the transplant recipient by using generalized estimating equations. In 22 transplant recipients with one right main duct-to-common duct anastomosis (ie, conventional donor anatomy), the distance between the donor's right main bile duct and hepatic artery generally was small (mean distance, 3.8 mm; range, 1-14 mm) and unrelated (P=.46) to biliary complications (n=6). In 22 recipients who required two second-order right duct anastomoses (ie, with variant donor anatomy), the distance between the donor's second-order duct and corresponding hepatic artery was more variable (mean distance, 6.6 mm; range, 1-32.5 mm), and biliary complications were significantly more common when this distance was 10 mm or greater (in eight of 13 ducts with conventional anatomy and four of 31 ducts with variant anatomy, P<.05). Right lobe liver graft recipients who have variant right biliary anatomy and a second-order bile duct 10 mm or farther from the corresponding hepatic artery are at high risk for biliary complications, possibly because of a predisposition to ischemic injury.