ANGIOGRAPHIC SELECTION CRITERIA FOR LIVING-RELATED LIVER-TRANSPLANT DONORS

OBJECTIVE. The purpose of this study is to better define arteriographi c selection criteria for living related liver transplantation (LRLT) b ased on literature review, technical and theoretical considerations, a nd correlation of patterns of variation in hepatic artery anatomy with recipient and donor outcomes. MATERIALS AND METHODS. Visceral angiogr ams of 92 consecutive living related liver transplant donors were retr ospectively reviewed by two radiologists and one transplant surgeon, A rterial, configurations were categorized. Recipient and donor outcomes were determined by a review of transplant surgery and radiology recor ds. RESULTS. Anomalous hepatic artery anatomy was identified in 67% of potential donors. A left hepatic artery (LHA) with a diameter of less than 2 mm was identified in 1%, and with a diameter of 2-3 mm, in 5%. A dual LHA supply to the left lateral segment was identified in 11%. Two subtypes were defined, Bifurcation of the LHA into branches enteri ng segment II and segment III less than 1 cm from the LHA origin was p resent in 8%, A replaced LHA from the left gastric artery (17%) and co mplex, aberrant branching of the LHA (4%) were identified. Vital LHA s upply to tissue other than the left lateral segment was present in 21% , including the cystic artery as a branch of the LHA (4%), significant supply of the right lobe from the LHA (5%), and large branches from t he LHA entering segment IV (13%), All three donors with significant su pply of the right lobe from the transplanted LHA had complications. CO NCLUSION. Absolute exclusionary criteria for LRLT are an LHA diameter of less than 2 mm, dual arterial supply to liver segments II and III, indeterminate arterial anatomy, preexisting vascular disease in donor liver, and a significant LHA supply to the right lobe, Relative exclus ionary criteria are an LHA diameter of 2-3 mm, early bifurcation of th e LHA, and arterial supply of segment 4 exclusively from the LHA.