Anatomical risk stratification for major portal vein complications in dual portal vein living donor liver transplantation: a retrospective cohort study
10.4174/astr.2026.110.6.366
- Author:
Hyun Hwa CHOI
1
;
Jae-Yoon KIM
;
Jiyoung KIM
;
Jaewon LEE
;
Su young HONG
;
YoungRok CHOI
;
Kwang-Woong LEE
;
Suk Kyun HONG
Author Information
1. Department of Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea
- Publication Type:ORIGINAL ARTICLE
- From:Annals of Surgical Treatment and Research
2026;110(6):366-373
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Right lobe living donor liver transplantation (LDLT) with dual portal veins (PVs) remains technically challenging.This study aimed to identify independent risk factors for PV complications.
Methods:We retrospectively analyzed 111 recipients of dual PV LDLT between 2011 and 2020. Recipient characteristics, anatomical geometry, and surgical factors were evaluated. Outcomes were overall PV complications and major PV complications (Clavien-Dindo grade ≥III). Logistic regression was performed.
Results:PV complications developed in 41 patients (36.9%), including 16 major events (14.4%). Univariate analysis revealed associations with right posterior PV (RPPV) diameter, axial angle, and coronal angle. On multivariate analysis, larger RPPV diameter (odds ratio [OR], 1.79; P = 0.041) and wider axial angle (OR, 1.08; P = 0.015) were independent predictors of major PV complications. Reconstruction method was not significant. Patients with overall major Clavien-Dindo grade ≥IIIcomplications had inferior 100-month survival (80% vs. 100%; P = 0.014, log-rank test).
Conclusion:In dual PV LDLT, anatomical geometry—specifically RPPV diameter and axial angle—independently predicts major PV complications, whereas surgical technique does not. Preoperative 3-dimensional imaging and anatomical risk stratification should inform donor selection and surgical planning.
