Introduction: Liver transplantation significantly prolongs life in patients with end stage liver disease and early-stage liver malignancy.
Liver transplantation from a living donor is a more complex and difficult method than liver transplantation from a cadaver. Because during the separation of the graft from the donor, the liver part that will remain in the donor and the vascularity of the graft must be preserved. For surgical planning, in addition to calculating volumetric data with multi detector tomography before the operation, the anatomy of the hepatic artery, portal vein and hepatic vein must be determined meticulously.
The most commonly used classification methods for hepatic artery variations are the Michels and Hiatt classifications. These classification methods can group most patients correctly. However, in our daily practice, we sometimes encounter many patients who cannot be grouped or who are accompanied by other variations in addition to the defined group.
Material and Method: Liver transplantation has been performed on a total of 760 patients in our hospital since 1988. 543 of these patients received liver transplantation from living donors.
In this study, we examined the hepatic artery computed tomography angiography tests taken before the operations of 290 live liver donors performed at our hospital between 2012 and 2023 and grouped the hepatic artery variations according to the Michels and Hiatt classifications. We also identified and classified the cases that could not be classified using either classification method.
Results: Many variations that did not comply with the Michels and Hiatt classifications were observed in our patient group. Especially the variations in the medial and lateral segmental branches of the left hepatic artery, the variations in the origin of the right hepatic artery, and the separation of the arteries in the form of trifucation are among the important variations that stand out.
Conclusion: Based on our data, Michels and Hiatt classification systems are inadequate in determining hepatic artery variations in many patients. We think that a more comprehensive classification system that includes segmental arteries should be developed.