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

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  < 0.001), as well as a cranial bifurcation position (52.0% vs. 13.3%, p  < 0.001). From the measurements obtained, cutoff values ​​were identified for the bifurcation angle of the left and right hepatic ducts at 91.8° and for the rotation axis at 30.0°. In multivariate analysis, the bifurcation angle (odds ratio [OR] 4.46), rotation axis (OR 4.96), and bifurcation position (OR 4.54) were independent risk factors. 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.