Intrahepatic bile duct anatomical variation in liver transplant donors and its implication in liver transplantation

Abstract Background For patients with end-stage liver disease, liver transplantation is considered the chief curative option. Radiological imaging has a pivotal role in evaluating both donors and recipients before and after transplantation. So the purpose of our study is to assess anatomical variant of intra-hepatic bile duct variation among liver transplant donors by MRCP and its implication in liver transplantation. Retrospective study was carried out in Mansoura University Hospitals over period from January 2019 till June 2022. Study included 64 liver transplant donors aged from 21 to 46 years old. All subjects underwent MRCP. Analysis of data obtained from images as well as reconstruction was performed to get images of bile ducts with a maximum intensity projection and volume rendering. Results Our study included 64 liver transplant donors. Donor mean age was 29.8 ± 2.57 years with range between 20 and 38 years. There were 40 males (62.5%) and 24 females (37.5%). Regarding right posterior hepatic duct drainage based on Huang classification, the type of bile duct variant was classified as follows: The most common variant was type A1 in 50% of the donors followed by type A4 in 20.3% then type A2 and type A3 in 14.1% each. The distance between RPHD insertion and junction between the right and left hepatic ducts (L) owns a surgical importance as it may need modification of surgical technique if L was more than 1 cm. So according to karakas classification, we had to subtype Huang A1 cases into K1 subtype (L > 1 cm) and K2a subtype (L ≤ 1 cm). Our subjects were 20 with K1 subtype (31.25%) and 12 with K2a subtype (18.75%). Conclusions Assessment of anatomical variation of right hepatic duct in liver transplant donor by non-invasive method as MRCP had a fundamental role to obtain successful surgical outcome and also to reduce hepatobiliary surgical complications.