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Intraoperative donor cholangiography

M Webb1, R Puig, F Khan

  • 1Department of Surgery, University of Miami School of Medicine, Miami, FL, USA.

Liver Transplantation and Surgery : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|July 3, 1998
PubMed
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Intraoperative donor duct cholangiograms (IODDCs) reveal significant biliary anomalies in liver transplant donors. Early identification of these variations is crucial for successful biliary reconstruction and improved transplant outcomes.

Area of Science:

  • Hepatobiliary Surgery
  • Transplant Surgery
  • Surgical Anatomy

Background:

  • Biliary complications are a major challenge in liver transplantation, impacting graft survival and patient outcomes.
  • Unrecognized anomalous biliary anatomy is a significant cause of these complications.
  • Intraoperative assessment of biliary anatomy is vital for successful surgical reconstruction.

Purpose of the Study:

  • To evaluate the utility of intraoperative donor duct cholangiograms (IODDCs) in identifying biliary anomalies.
  • To determine the incidence of various biliary anomalies in liver transplant donors.
  • To assess the discrepancy between radiographic and clinical recognition of biliary anomalies.

Main Methods:

  • Analysis of 73 intraoperative donor duct cholangiograms (IODDCs).

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  • Classification and quantification of identified biliary anatomical variations.
  • Comparison of radiographic recognition with clinical recognition of anomalies.

    • Main Results:

    • 42% of donors had normal biliary anatomy.
    • Significant variations included right-sided drainage into the left duct (22%), trifurcated systems (16%), low hepatic duct insertion (11%), and right segmental duct drainage into the cystic duct (8%).
    • Radiographic recognition of anomalies was more than double the clinical recognition rate.

    Conclusions:

    • IODDCs are effective in identifying biliary anomalies during liver transplantation.
    • Awareness of these anomalies, particularly those involving the cystic duct, is critical for meticulous biliary reconstruction.
    • IODDCs aid in training transplant fellows and have low cost and nil morbidity.