>From the Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2024 Sep;22(9):691-697. doi: 10.6002/ect.2024.0121.
Liver transplant from a living donor is a more challenging procedure than liver transplant from a deceased donor, given that optimal blood supply to both the remaining liver segment in the donor and the graft must be maintained to ensure successful donor hepatectomy. During surgical planning, in addition to calculation of volumetric data with multidetector tomography, the anatomy of the hepatic artery, portal vein, and hepatic vein must also be meticulously determined, with the most commonly used clas-sification methods for hepatic artery variations being the Michels and Hiatt classifications. Although these classification methods can accurately group most patients, we often encounter a large number of patients who cannot be grouped or who exhibit other variations that accompany the defined group.
We examined the hepatic artery computed tomography angiography tests taken before the operations of 290 living liver donors performed at our hospital between 2012 and 2023 and grouped the hepatic artery variations according to the Michels and Hiatt classifications. We also identified and classified cases that could not be classified into the groups of either classification method.
We identified 144 patients (62.61%) who fit the Michels classification. Eighty-six patients (37.39%) did not conform to the groups defined in either classification system. We identified 173 patients (75.22%) patients who fit the Hiatt classification, and 57 (24.78%) who did not. Notable variations included those in the medial and lateral branches of the left hepatic artery, those in the origin of the right hepatic artery, and the trifurcation of the common hepatic artery into the gastroduodenal artery, right hepatic artery, and left hepatic artery.
The Michels and Hiatt classification systems are not sufficient for determining hepatic artery variations in many patients. A more comprehensive classification system that includes segmental arteries is needed.
与来自已故供体的肝移植相比，来自活体供体的肝移植是一个更具挑战性的过程，因为必须维持供体剩余肝段和移植物的最佳血液供应，以确保供体肝切除术的成功。在手术规划中，除了使用多排螺旋 CT 计算容积数据外，还必须仔细确定肝动脉、门静脉和肝静脉的解剖结构，肝动脉变异最常用的分类方法是 Michels 和 Hiatt 分类法。尽管这些分类方法可以准确地对大多数患者进行分组，但我们经常会遇到大量无法分组或伴有定义组的其他变异的患者。
我们检查了 2012 年至 2023 年在我院进行的 290 例活体肝供者手术前的肝动脉 CT 血管造影检查，并根据 Michels 和 Hiatt 分类法对肝动脉变异进行分组。我们还确定并分类了无法归入任何分类方法组的病例。
我们确定了 144 例（62.61%）符合 Michels 分类的患者。86 例（37.39%）不符合两种分类系统定义的组。我们确定了 173 例（75.22%）符合 Hiatt 分类的患者，57 例（24.78%）不符合。值得注意的变异包括左肝动脉的内侧和外侧分支、右肝动脉的起源以及肝总动脉的三分叉进入胃十二指肠动脉、右肝动脉和左肝动脉。
Michels 和 Hiatt 分类系统不能充分确定许多患者的肝动脉变异。需要一种更全面的分类系统，包括节段性动脉。
