Biliary Complications After Single- and Dual-Graft Living-Donor Liver Transplantation Using a Right Posterior Section Graft of Donor with a Type III Portal Vein Variation

Abstract

Background: When the donor's left lobe volume is <30%, donor selection for the right posterior section graft (RPSG) is based on the type III portal vein (PV) anatomic variation. Herein, we validated the selection of a donor with a type III PV variation for RPSG to prevent biliary complications (BCs) after single-graft (SG) and dual-graft (DG) living-donor liver transplantation (LDLT).

Methods: The clinical data of recipients and donors with a type III PV variation for LDLT using an RPSG performed between January 2004 and June 2018 were retrospectively collected and analyzed to determine the occurrence of BCs.

Results: The 26 LDLTs performed using an RPSG, including 20 DG LDLT cases, accounted for 0.6% of all LDLT cases (n=4292). BCs developed in 6 recipients (23.0%), including biliary stricture in 4 (15.3%) and bile leakage in 2 (7.6%). No vascular complications occurred. The RPSG volume was significantly smaller in recipients with BCs than in those without BCs (400.8±79.9 vs 504.1±96.5 mL, P = .015). The bile duct types were A, B, C1, C2, and D in 6 (18.8%), 5 (15.6%), 3 (9.4%), 13 (40.6%), and 5 (15.6%) patients, respectively. All the RPSGs had a single-orifice bile duct. The bile duct size of the RPSG was relatively smaller in recipients with BCs than in those without BCs (2.8±1.0 vs 3.6±1.4 mm, P = .237).

Conclusions: When the left liver volume is disproportionately small, selection of a donor with a type III PV variation can prevent BCs after SG and DG LDLTs using an RPSG.