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Anatomical variations in living donors for liver transplantation—prevalence and relationship

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Data availability

Data can be provided upon reasonable request.

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Authors and Affiliations

  1. Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan

    Abdullah Khalid, M. Asad Saleem,  Ihsan-ul-Haq, Yasir Khan, Sohail Rashid & Faisal Saud Dar

Authors
  1. Abdullah Khalid
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  2. M. Asad Saleem
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  3. Ihsan-ul-Haq
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  4. Yasir Khan
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  5. Sohail Rashid
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  6. Faisal Saud Dar
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Abdullah Khalid and M. Asad Saleem. Abdullah Khalid wrote the first draft of the manuscript, and all authors commented on previous versions. All authors read and approved the final manuscript.

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Correspondence to Abdullah Khalid.

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The authors declare no competing interest.

Ethics approval and consent to participate

The study was approved by the Institutional Review Board at Pakistan Kidney and Liver Institute & Research Center.

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Khalid, A., Saleem, M.A., Ihsan-ul-Haq et al. Anatomical variations in living donors for liver transplantation—prevalence and relationship. Langenbecks Arch Surg 408, 323 (2023). https://doi.org/10.1007/s00423-023-03066-1

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