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Hepatic arterial variations and liver-related diseases of 100 consecutive donors
H Mäkisalo1, E Chaib, N Krokos
1Department of Surgery, Addenbrooke's Hospital, University of Cambridge, UK.
Insights
Liver donor operations reveal frequent anatomical variations and diseases. Only two-thirds of donor livers were normal, highlighting the need for thorough screening of hepatic artery anomalies and liver conditions.
Area of Science:
- Surgical Anatomy
- Transplantation Medicine
- Hepatology
Background:
- Liver transplantation is a life-saving procedure.
- Donor liver quality is critical for successful outcomes.
- Understanding anatomical variations and pathologies in donor livers is essential.
Purpose of the Study:
- To prospectively investigate anatomical variations and diseases of the liver in consecutive organ donors.
- To determine the incidence of hepatic artery anomalies and liver pathologies.
- To assess the implications for organ procurement and transplantation.
Main Methods:
- Prospective study of 100 consecutive liver donor operations over one year.
- Detailed examination of liver anatomy, focusing on hepatic artery variations.
- Histological and macroscopic assessment for liver diseases and pathologies.
Main Results:
- Normal hepatic artery anatomy observed in 76% of cases.
- Seven of twelve major hepatic artery variations were considered rare, with one novel finding.
- 6% of livers were discarded due to infection (3%), polycystic disease (1%), hypoperfusion, or severe steatosis (3%).
- Benign tumors were found in 3% of donors.
- Only 66% of donor livers were deemed completely normal.
Conclusions:
- Significant anatomical variations of the hepatic artery exist, necessitating careful intraoperative identification.
- Liver-related diseases, including steatosis and tumors, are prevalent in donors and can impact graft viability.
- Thorough screening for both vascular anomalies and liver pathologies during organ harvesting is crucial for optimizing liver transplantation outcomes.
Abstract:
We prospectively studied anatomical variations and diseases of the liver in 100 consecutive donor operations during a period of 1 year. The "normal" arterial anatomy with a single hepatic artery (HA) from the celiac trunk was seen in 76% of all cases. Seven of twelve different major variations of the HA may be considered as "rare", one of which cannot be found in the earlier literature. During harvesting, 6% of the livers were discarded, 3% on the basis of infection and 1% because of a polycystic disease. Two cases were rejected as the liver was found to be severely hypoperfused or hypoxic in an otherwise stable donor. Severe steatosis was macroscopically and histologically diagnosed in 3% of the cases, and in three donors a benign tumour was found in the liver or in the gall bladder. Two primarily nonfunctioning livers in the present series of 94 recipient operations were retrieved from this group of severely steatotic livers. As the donor liver was totally "normal" in only 2 out of 3 of the cases, the present study underlines the importance of searching for extremely variable anomalies of the HA and for liver-related diseases during organ harvesting.