Angiographic selection criteria for living related liver transplant donors

OBJECTIVE. The purpose of this study is to better define arteriographic selection criteria for living related liver transplantation (LRLT) based on literature review, technical and theoretical considerations, and correlation of patterns of variation in hepatic artery anatomy with recipient and donor outcomes. MATERIALS AND METHODS. Visceral angiograms of 92 consecutive living related liver transplant donors were retrospectively reviewed by two radiologists and one transplant surgeon. Arterial configurations were categorized. Recipient and donor outcomes were determined by a review of transplant surgery and radiology records. RESULTS. Anomalous hepatic artery anatomy was identified in 67% of potential donors. A left hepatic artery (LHA) with a diameter of less than 2 mm was identified in 1%, and with a diameter of 2-3 mm, in 5%. A dual LHA supply to the left lateral segment was identified in 11%. Two subtypes were defined. Bifurcation of the LHA into branches entering segment II and segment III less than 1 cm from the LHA origin was present in 8%. A replaced LHA from the left gastric artery (17%) and complex, aberrant branching of the LHA (4%) were identified. Vital LHA supply to tissue other than the left lateral segment was present in 21%, including the cystic artery as a branch of the LHA (4%), significant supply of the right lobe from the LHA (5%), and large branches from the LHA entering segment IV (13%). All three donors with significant supply of the right lobe from the transplanted LHA had complications. CONCLUSION. Absolute exclusionary criteria for LRLT are an LHA diameter of less than 2 mm, dual arterial supply to liver segments II and III, indeterminate arterial anatomy, preexisting vascular disease in donor liver, and a significant LHA supply to the right lobe. Relative exclusionary criteria are an LHA diameter of 2-3 mm, early bifurcation of the LHA, and arterial supply of segment 4 exclusively from the LHA.