A rare aberrant infraportal B2/3 bile duct of left hepatic lobe graft in living donor

• Published in: Japanese Journal of Transplantation Vol. 54; no. 6; pp. 299 - 303
• Main Authors: TAKAHASHI, Naoki, GOTO, Ryoichi, ZAITSU, Masaaki, KAWAMURA, Norio, WATANABE, Masaaki, KAMIYAMA, Toshiya, SHIMAMURA, Tsuyoshi, TAKETOMI, Akinobu
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society for Transplantation 2019
• Subjects: infraportal B2/3 bile duct; living liver transplantation
• ISSN: 0578-7947; 2188-0034
• DOI: 10.11386/jst.54.6_299

A woman in her 20s underwent a left hepatectomy of living donor for her father who diagnosed with cryptogenic severe liver cirrhosis (CTP score of 13 (grade C), MELD score of 27). The preoperative enhanced CT examination revealed a normal liver appearance without steatosis and could not detect any aberrant hepatic vessels. The volume of left hepatic lobe was estimated 378 mL which was equivalent to 32.0% of graft volume / standard liver volume ratio. The graft was rather small in size but estimated eligible for a living donor as taking the donor age into consideration.During left hepatectomy, the aberrant infraportal B2/3 bile duct was detected and confirmed by the intraoperative cholangiogram. We carefully dissected the hepatic hilum and transected the B2/3 and B4 ducts separately under real-time C-arm cholangiography. These two bile duct orifices were made into one on the back table. Both the donor and recipient were discharged with good post-transplant course without any clinical events. To perform a promising, a safe living donor liver transplantation, a gentle and careful maneuver with well-understanding, knowledge and expectation of the anatomical aberrant findings of the liver are necessary. To be cautiously aware of a rare aberrant anatomy at risk such as infraportal B2/3 bile duct guarantee the safety and high quality of living donor hepatectomy.