The impact of donor’s biliary anatomy variations on the procedure of living donor liver transplantation

Abstract

Background Anatomical variation of biliary anatomy is the cornerstone for the procedure of living donor liver transplantation (LDLT). Aim The aim was to study the effect of donor’s biliary variant anatomy on the procedure of adult LDLT. Participants and methods A retrospective study was conducted using the data of all donors and recipients of LDLT (June 2013–December 2017) in HPB Department and Liver Transplant Surgery. A total of 120 potential donors were assessed preoperatively by MRCP to evaluate the biliary anatomy of the liver and classified into four types according to Varotti and colleagues. Results Of 120 donors, 13 (10.8%) were excluded from donation before surgery owing to various causes; six (46.1%) of them were excluded owing to donor’s biliary anatomical variation. According to the classification of Varotti and colleagues, biliary variations were seen in 27 (25.2%) of 107 donors (five of type 2, 14 of type 3a, and eight of type 3b); type 1 with short stump was seen in 25 (23.1%) cases. Biliary complications (BCs) occurred in 53 (49.5%) of 107 recipients, including bile leak in 40 (37.5%) cases, biliary strictures in 13 (12.1%) cases, and concomitant biliary stricture and leak in 17 (15.9%) cases. There was a statistically significant correlation between the presence of donor’s right hepatic duct (RTH) duct (type 1 with short stump) and BCs in their recipients (P=0.04). There was a statistically significant between the occurrence of BCs in recipient and hospital stay (P=0.046). BCs presented in eight (7.4%) donors, where six (5.6%) of them had bile leak and two (1.8%) had a biliary stricture. Anatomical biliary variations were a risk factor for potential donor exclusion (P=0.021). Conclusions There was a statistically significant difference between donor’s RTH (type 1 with short stump) and BCs in their recipients, and between the occurrence of BCs in recipient and hospital stay. Donor biliary anatomical variations had a statistically significant effect for potential donor’s exclusion.