Accessory right hepatic artery arising from the left: implications for split liver transplantation

Area of Science:

• Hepatobiliary surgery
• Vascular anatomy
• Transplantation surgery

Background:

• Variant arterial anatomy is critical in split liver transplantation to ensure adequate vascular supply for both grafts.
• An accessory posterior right hepatic artery originating from the left hepatic artery and coursing behind the portal vein bifurcation is described.

Purpose of the Study:

• To identify and characterize an accessory posterior right hepatic artery variant encountered during ex vivo liver splitting.
• To assess the implications of this anatomical variant on the suitability of livers for splitting in transplantation.

Main Methods:

• Examination of 37 consecutive livers during ex vivo liver-splitting procedures.
• Identification of an abnormal right accessory artery arising from the left hepatic artery.
• Anatomical description and illustration using methylene blue injection and arteriography.

Main Results:

• The accessory posterior right hepatic artery variant was identified in 2 out of 37 (5.4%) split liver procedures.
• The right lobes associated with this anomaly were unsuitable for transplantation and were discarded.

Conclusions:

• Meticulous dissection behind the portal vein bifurcation is essential to detect accessory segmental right hepatic arteries.
• The presence of this variant may preclude liver splitting without compromising the right lobe's vascular supply.
• Division of the left hepatic artery distal to the accessory vessel's origin may be a potential management strategy.