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September 5, 2025Open Access

Effects of the Bile Duct Bifurcation Angle and Position of the Living Donor on Biliary Complications in Recipients after Living Donor Liver Transplantation

Key Points

Biliary complications occurred in 20.3% of recipients, associated with increased bifurcation angle and rotation axis.
The maximum bifurcation angle was significantly larger in those with complications, at 105.9° compared to 83.6°.
Independent risk factors include bifurcation angle and position of the hepatic ducts, with odds ratios above 4.4.
This study supports the need for thorough preoperative assessments of donor biliary anatomy before transplants.

Abstract

Abstract Background:This study aims to search for new risk factors for biliary complications (BCs) in recipients after living donor liver transplantation (LDLT), focusing on the biliary anatomy of the donor.Methods:The study included 123 patients who underwent donor hepatectomies. Anatomical variations in biliary branching patterns, the maximum bifurcation angle of the left and right hepatic ducts, the rotation axis of the hepatic ducts, the bifurcation position of the hepatic ducts, and the bile duct diameter were evaluated with the occurrence of BCs.Results:BCs occurred in 25 recipients (20.3%), who had a larger bifurcation angle (83.6° vs. 105.9°, p = 0.001) and rotation axis (13.8° vs. 25.6°, p p Conclusions:This study demonstrated a potential association between the biliary anatomy of donors and BCs and suggested the importance of a detailed preoperative evaluation of the donor biliary anatomy.

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