Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan.
Langenbecks Arch Surg. 2023 Aug 19;408(1):323. doi: 10.1007/s00423-023-03066-1.
Living donor liver transplantation (LDLT) is a widely accepted option to address the lack of a deceased liver program for transplantation. Understanding vascular and biliary anatomy and their variants is crucial for successful and safe graft harvesting. Anatomic variations are common, particularly in the right hepatic lobe. To provide evidence for screening potential liver transplant donors, the presence of vascular and biliary anatomic variations in Pakistan's preoperative assessment of transplantation donor candidates was explored.
This retrospective cross-sectional study evaluated the hepatic artery, portal vein, hepatic vein, and biliary variations in living liver donors. The study included 400 living liver donors; data were collected from March 2019 to March 2023. We used a CT scan and MRCP to assess the anatomical variations.
The study examined 400 liver donors aged 18 to 53 years. Conventional arterial anatomy was the most common (65.8%), followed by replaced right hepatic artery (16%) and replaced left hepatic artery (10.8%). Conventional type 1 biliary anatomy was seen in 65.8% of cases. The dominant right hepatic vein was found in 13.3% of donors. There was a significant association between the prevalence of variant portal venous anatomy with variant biliary anatomy.
Variations of the hepatic arterial, portal venous, and biliary systems are frequent and should be carefully evaluated while selecting a suitable living donor. A strong relationship between variant portal venous and biliary anatomy was found. These findings can aid in selecting suitable candidates and improving surgical planning for liver transplantation.
活体供肝移植（LDLT）是解决供体肝缺乏问题的一种广泛接受的选择。理解血管和胆道解剖及其变异对于成功和安全的移植物获取至关重要。解剖变异很常见，尤其是在右肝叶。为了为潜在的肝移植供体筛查提供依据，本研究探讨了巴基斯坦术前评估移植供体候选者的血管和胆道解剖变异情况。
这是一项回顾性的横断面研究，评估了活体肝供者的肝动脉、门静脉、肝静脉和胆道变异情况。该研究纳入了 400 名活体肝供者，数据采集时间为 2019 年 3 月至 2023 年 3 月。我们使用 CT 扫描和 MRCP 来评估解剖变异情况。
本研究共检查了 400 名年龄在 18 至 53 岁的肝供者。常规动脉解剖最为常见（65.8%），其次是替代右肝动脉（16%）和替代左肝动脉（10.8%）。常规型 1 胆道解剖见于 65.8%的病例。13.3%的供者存在优势右肝静脉。变异型门静脉解剖与变异型胆道解剖的流行率之间存在显著关联。
肝动脉、门静脉和胆道系统的变异很常见，在选择合适的活体供者时应仔细评估。我们发现变异型门静脉和胆道解剖之间存在很强的关系。这些发现有助于选择合适的候选者，并改善肝移植的手术规划。
