Background: Living donor liver transplant (LDLT) has developed tremendously as a savage therapy for chronic liver disease and malignancy. To optimize the procedure outcome, expert knowledge of surgical liver anatomy variations surgical techniques and pitfalls is essential. Our study aims to evaluate the biliary anatomy variation according to Varoti classification and its correlation with surgical outcomes for both donors and recipients undergoing LDLT.
Methods: We conducted a retrospective analysis of 150 LDLT cases performed at a single center in Vietnam. Preoperative radiologic evaluations and intraoperative surgical assessments were utilized to identify biliary variant anatomy. Postoperative complications, including biliary complications, were documented and analyzed. Statistical analysis was performed to determine any significant associations between biliary variations and posttransplant outcomes.
Results: Our study included 150 cases of LDLT at 108 Military Central Hospital from October 2017 to December 2022. Among the donors, the mean age was 30.89±7.23, with male predominance (77.3%). The prevalence of type 1 biliary anatomy was 84.67%. Type 2, 3a, 3b, 4a, and 4b accounted for 5.33%, 2.67%, 5.33%, 0.67%, and 1.33% of cases, respectively. Donors complications were witnessed in seven cases (4.67%), and all needed intervention (Clavien-Dindo grade 3). Biliary complications were found in 36 recipients (24.0%), with 22 (14.67%) cases of biliary stenosis and 16 (10.67%) cases of biliary leak, including two cases encountering both complications. Age, gender, graft type, preoperative liver function, biliary variant anatomy, number of graft orifices, model for end-stage liver disease score, and blood loss were not significant risk factors for recipients’ biliary complications. Cold ischemia time significantly increased the biliary complication rate.
Conclusions: According to our study, biliary variant anatomy is common in liver transplantation donors. However, such variations should not be considered a contraindication to donation but require accurate pre- and intraoperative radiologic and surgical evaluations to plan a careful reconstruction.