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Relationship Between Vascular and Biliary Anatomy in Living Liver Donors

¹ Department of Medical Imaging, Princess Margaret Hospital, University Health Network, University of Toronto, 610 University Ave., Toronto, ON M5G 2M9, Canada.
² MultiOrgan Transplantation Unit, Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, ON, Canada.
³ Department of Biostatistics, University Health Network, Princess Margaret Hospital, Toronto, ON, Canada.

OBJECTIVE. The objective of our study was to determine whether there is an association between portal venous or hepatic arterial branching patterns (or both) and biliary anatomic variants.

MATERIALS AND METHODS. Two radiologists independently reviewed preoperative hepatic CT scans and intraoperative cholangiograms from 39 consecutive living liver donors. The portal venous and hepatic arterial anatomy was classified on the basis of the preoperative CT scans and the biliary anatomy was classified on the basis the intraoperative cholangiograms into one of two groups: conventional or anomalous. Variables were tested for association using Fisher's exact test.

RESULTS. Anomalous vascular branching variants were common, being present in 23 (59%) of 39 patients. Hepatic arterial anomalies were present in 18 (46%); portal venous anomalies, in seven (18%); and both, in two (5%). Biliary anomalies were present in 15 (38%) of the 39 patients. Of the 23 patients with anomalous vascular anatomy, seven (30%) had biliary anomalies. Of the 16 patients with conventional vascular anatomy, eight (50%) had biliary anomalies. There was no significant association between hepatic arterial anomalies, portal venous anomalies, or the combination of arterial and portal venous anomalies and anomalous biliary drainage.

CONCLUSION. Portal venous and hepatic arterial branching patterns do not correlate well with biliary anatomic variants. In patients with normal hepatic vascular anatomy, biliary anomalies are common.

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