Impact of Donor Variant Anatomy on Graft Reconstruction in Living Donor Liver Transplantation

Abstract

Abstract Background Living donor liver transplantation (LDLT) is a definitive treatment option in Asian countries where deceased donation is scarce. Various anatomical variations may occur, posing a significant challenge to liver transplant surgeons. This study aimedto evaluate the impact of a donor’s variant anatomy on graft reconstruction in liver transplantation. Methods Aretrospective analysis of 400 LDLTfrom March 2019 to March 2023 was conducted. Clinical data and operative details were collected. Kaplan Meier curve was used for biliary complications and survival. Results This study included 400 patients with a mean age of 43. There were 48 mortalities after a median follow-up of 18 months. The study found a significant relationship between cold ischemia time and portal vein anatomy type (p-value < 0.001). The most common graft arterial reconstruction was with RHA of the recipient (82.6%) and five (1.5%) anastomosed directly to the aorta via autologous saphenous vein graft. For most grafts with dual orifice, autologous Portal Vein Y-graft was used. There was no significant association between biliary reconstructive technique and biliary complications (p=0.50). Ductoplasty and anastomosis with higher biliary radicals were associated with a higher rate of biliary complications; 28% and 23%, respectively. The survival rates were 91% for biliary complications, 80% for HAT, and 92% for PVT. The overall survival rate was 88%. Conclusions A good outcome can be achieved with appropriate preoperative planning and modification of surgical technique. There was no association between biliary reconstructive technique and biliary and vascular complications.