The Anatomical Landscape of Living Donor Livers: A 101-Case Retrospective Single-Center Study in Indonesia From 2010 to 2025.

BACKGROUND Anatomical variations of the hepatic vasculature and bile ducts are critical considerations in living donor liver transplantation (LDLT), yet population-specific data remain limited. This retrospective study aimed to evaluate hepatic artery, portal vein, hepatic vein, and intrahepatic bile duct anatomy in 101 living liver donors at a single center in Indonesia from 2010 to 2025, and to identify donor characteristics associated with these variations. MATERIAL AND METHODS A retrospective review was performed on 101 living liver donors at Cipto Mangunkusumo Hospital, Indonesia (2010-2025). Hepatic artery and portal/hepatic vein anatomy were assessed using computed tomography angiography (CTA), and biliary anatomy using magnetic resonance cholangiopancreatography (MRCP). Variations were classified according to the Michel, Nakamura, and Huang systems. Logistic and multinomial regression analyses evaluated demographic predictors, and linear regression assessed operative time. RESULTS Donors (mean age 31.8±6.2 years; body mass index [BMI] 22.6 kg/m²; 62.5% female) were predominantly Javanese and Sumatran. Canonical anatomy predominated (Michel I 70.8%; Nakamura I 71.9%; Huang A1 59.7%). Sumatran donors demonstrated higher frequencies of hepatic artery and portal vein variants. Increasing age predicted hepatic artery variation (aOR 1.08/year, P=0.046), while BMI influenced portal vein subtypes (P=0.006). No factors affected operative time. CONCLUSIONS Canonical anatomy predominated, with ethnic variations seen in Sumatran donors. Age and BMI predicted vascular variations, while biliary anatomy remained stable. Anatomical variations did not affect operative time, highlighting the importance of preoperative imaging and planning.