DONOR BILIARY VARIATIONS - AN OVERLOOKED PROBLEM

Documented causes of biliary complications following orthotopic liver transplantation have been related to technical imperfections or insuff icient arterial supply. Although anatomical variations of the extrahep atic biliary system are not infrequent, neither their incidence, surgi cal management nor possible association with complications have been r eported in liver transplantation. At our institution, the global incid ence of biliary complications following 357 consecutive liver transpla nts performed in 324 patients over a 2-yr period was 15.4% (55/357). A nomalous donor extrahepatic ducts were verified in 10 cases (2.8%) and they were recognized intraoperatively, prior to biliary reconstructio n, in 7 cases. Technical complications occurred in 1 of these 7 and in 3 other cases where the anomalous ducts were not identified until lat er in the postoperative period when serious clinical problems ensued. We herein present a description of these 10 cases, with reference to t he techniques employed to manage the anatomical anomalies and to treat complications. As in any hepatobiliary procedure, awareness of possib le variations of the extrahepatic biliary system, intraoperative ident ification of the anomalous ducts and appropriate tailoring of the surg ical technique are advisable in order to avoid serious postoperative c omplications in Liver transplantation.