Living donor liver transplantation (LDLT) using right liver grafts is now widely performed. Anatomic classifications of the hepatic artery for right liver procurement, however, are limited. In this study, celiac and mesenteric angiograms of 223 consecutive living donors in a single institution were evaluated. Details of the arterial anastomosis and results were reviewed in 72 patients who underwent primary LDLT using right liver grafts. There was a 6% incidence of hepatic arterial bifurcations that might provide multiple orifices in a right liver graft. Only one right liver graft (1%) had multiple arterial orifices. Single arterial anastomosis without interposition was possible in all patients with right liver grafts and none of them were complicated with hepatic arterial thrombosis. Single arterial anastomosis, therefore, has a high probability of success in right liver graft implantation. (Liver Transpl 2004;10:129 -133.)
L iving donor liver transplantation (LDLT) is a pref- erable treatment for adults with end-stage liver disease due to the limited number of available cadaveric donors. 1 Fundamental to the application of this technique is an understanding of hepatic vascular anatomy. 2 Michels first reported 10 basic types of hepatic arterial supply. 3 Since then, common and rare hepatic artery variants have been reported. Most of these studies, however, focused only on replaced or accessory arterial branches that are helpful for whole-liver harvesting and transplantation. Without information regarding bifurcation of the right hepatic artery (RHA), the classification is of little help for right liver harvesting.
Recently, Marcos et al proposed the use of interposition arterial grafts in right liver graft because double hepatic arteries were common in their series. 7 Their report conflicted with our experience because, in our series, no patients underwent double hepatic artery reconstruction in right liver LDLT. To clarify this inconsistency, we evaluated celiac and mesenteric angiograms of 223 consecutive living donors in a single institution. The aim of the study was to determine a useful anatomic classification of the hepatic arteries for LDLT using right liver grafts.