INTRAOPERATIVE DONOR CHOLANGIOGRAPHY

Biliary drainage has long been called the Achilles' heel of liver tran splantation, and biliary complications compromise the success of liver transplantation by increasing graft loss and the rates of a required second operation, morbidity, and mentality. One cause of complications is unrecognized anomalous biliary anatomy. We examined 73 intraoperat ive donor duct cholangiograms (IODDCs) to assess our ability to identi fy biliary anomalies intraoperatively. Normal anatomy was seen in 42% (31/73); some part of the right-sided biliary system drained into the left bile duct in 22% (16/73); trifurcated systems with a single branc h point for the right posterior, right anterior, and left ducts appear ed in 16% (12/73); low insertion of a right segmental duct to the hepa tic duct was seen in 11% (8/73); and drainage of a right segmental duc t into the cystic duct or into the hepatic duct at the cystic duct ori gin was noted in 8% (6/73), It was believed that the last group repres ented a condition that dictated extra caution in biliary reconstructio n, The incidence of radiographic recognition of these anomalies was mo re than twice the clinical recognition in our patient population, impl ying that many such ''problem'' ducts usually go unrecognized. IODDCs facilitate training of transplant fellows, Costs are low, and morbidit y is nil, Copyright (C) 1998 by the American Association for the Study of Liver Diseases.