AUTHOR=Yamaguchi Naotaka , Matsuyama Ryusei , Kikuchi Yutaro , Sato Sho , Yabushita Yasuhiro , Sawada Yu , Homma Yuki , Kumamoto Takafumi , Takeda Kazuhisa , Morioka Daisuke , Endo Itaru , Shimada Hiroshi 

TITLE=Role of the Intramural Vascular Network of the Extrahepatic Bile Duct for the Blood Circulation in the Recipient Extrahepatic Bile Duct Used for Duct-to-Duct-Biliary-Anastomosis in Living Donor Liver Transplantation

JOURNAL=Transplant International

VOLUME=35

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10276

DOI=10.3389/ti.2022.10276

ISSN=1432-2277

ABSTRACT=<p>A duct-to-duct-biliary-anastomosis is the preferred biliary reconstruction technique in liver transplantation; biliary complications remain the major concerns for the technique. We examined the significance of the intramural vascular network of the extrahepatic bile duct (EBD) and its relevant vessels. We microscopically examined the axial sections of the EBD with 5 mm intervals of 10 formalin-fixed deceased livers. The luminal-areas of the 3 and 9 o’clock arteries correlated significantly and positively with the distance from the bifurcation of the right and left hepatic ducts (the 3 o’clock artery, <italic>r</italic> = 0.42, <italic>p</italic> &lt; 0.001; the 9 o’clock artery, <italic>r</italic> = 0.39, <italic>p</italic> &lt; 0.001); the ratios of the numbers of the intramural vessels to the areas of the corresponding sections of the EBD significantly correlated positively with the distance from the bifurcation of the right and left hepatic ducts (total vessels, <italic>r</italic> = 0.78, <italic>p</italic> &lt; 0.001; arterioles, <italic>r</italic> = 0.52, <italic>p</italic> &lt; 0.001; venules, <italic>r</italic> = 0.45, <italic>p</italic> &lt; 0.001). This study demonstrated that there is a significant locoregional distributional heterogeneity of the intramural vessels among the EBD. The hepatic arteries neighboring the EBD primarily supply the blood flow to the EBD; thus, when the broader isolation of the EBD from the neighboring arteries is necessary, this locoregional distributional heterogeneity of the intramural vessels may render the EBD likely to suffer ischemia of the anastomotic site.</p>