Korean J Transplant.  2023 Nov;37(Suppl 1):S183. 10.4285/ATW2023.F-7693.

Impact of donor hepatic duct bifurcation location and angle on posttransplant biliary complications in recipients following living donor liver transplantation

• Park S
• Choi GS
• Rhu J
• Kim JM
• Joh JW
• Oh N
• An S
• Jo SJ
• Han SW

• KMID: 2551803
• DOI: http://doi.org/10.4285/ATW2023.F-7693

Abstract

Background
Biliary complication remains an unresolved issue in liver transplantation, despite improvements in surgical techniques and perioperative care. The aim of this study was to evaluate the influence of the location of hepatic duct bifurcation in donors with type I bile duct on posttransplant biliary complications in recipients.
Methods
We retrospectively analyzed 109 cases of living donor liver transplantation from January 2021 to December 2022. All donors had type I bile duct, and donor hepatectomies were performed laparoscopically by a single surgeon. We used indocyanine green fluorescence to determine the location of the hepatic duct bifurcation, which was classified into intrahepatic and extrahepatic. The bifurcation angle was assessed via three-dimensional modeling and reconstruction from preoperative magnetic resonance cholangiopancreatography images.
Results
There were 76 and 33 cases in the extrahepatic and intrahepatic bifurcation groups, respectively. The groups significantly differed in terms of Model for End-stage Liver Disease score, posttransplant hepatic artery-related complications, and hepatic duct bifurcation angle. The surgical outcomes of donors were not different between the two groups. The intrahepatic bifurcation group showed lower biliary complication-free survival in recipients (P=0.018). We identified a cut-off point of 91.5 degrees (area under the curve=0.887) for the bifurcation angle to predict extrahepatic and intrahepatic bifurcation. Comparing biliary complication-free survival based on this cut-off, we observed a trend towards worse survival in those with an angle greater than 91.5 degrees, although the difference was not statistically significant. Upon multivariable analysis, the recipient’s body mass index (hazard ratio [HR], 1.12; P=0.006) and an intrahepatic location of the donors bile duct bifurcation (HR, 1.941; P=0.035) emerged as independent risk factors for biliary complications in recipients.
Conclusions
The findings of this study highlight that the location of hepatic duct bifurcation in donors significantly impacts posttransplant biliary complications in recipients. The results also suggest the potential predictive value of the bifurcation angle, emphasizing the importance of precise anatomical assessment before transplantation.