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 was intended to identify new risk factors for biliary complications (BCs) in recipients after living donor liver transplantation (LDLT), focusing on the biliary anatomy of the donor. METHODS: A total of 123 living donors who underwent donor hepatectomy between 2007 and 2024 were retrospectively analyzed. Using three-dimensional reconstructed drip infusion cholangiographic computed tomography images, we evaluated biliary branching patterns, the maximum bifurcation angle and rotation angle of the hepatic ducts, and the bifurcation position relative to the portal vein. RESULTS: BCs occurred in 25 recipients (20.3%). Donors who developed BCs had a wider bifurcation angle (105.9° versus 83.6°, p = 0.001), a greater rotation angle (25.6° versus 13.8°, p < 0.001), and a more cranial bifurcation position (52.0% versus 13.3%, p < 0.001). Receiver operating characteristic analysis identified cutoff values of 91.8° for bifurcation angle (area under the curve [AUC]: 0.731; 95% CI: 0.63–0.83) and 30.0° for rotation angle (AUC: 0.691; 95% CI: 0.56–0.82). Multivariate logistic regression revealed that bifurcation angle (odds ratio [OR]: 4.46), rotation angle (OR: 4.96), and bifurcation position (OR: 4.54) were independent risk factors for BCs. CONCLUSIONS: This study suggests that donor biliary anatomy may be associated with the risk of BCs, underscoring the importance of detailed preoperative evaluation in living donor selection.