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=Volume 35 - 2022

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=Duct-to-duct-biliary-anastomosis is the preferred biliary-reconstruction-technique in liver-transplantation; biliary-complications remain the major concerns; we examined the significance of the intramural-vascular-network of the extrahepatic bile duct (EBD) and its relevant vessels. We examined microscopically 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 significantly correlated positively with the distance from the bifurcation-of-the-right-and-left-hepatic-ducts (the 3 o’clock artery, r = 0.42, p < 0.001; the 9 o’clock artery, r = 0.39, p < 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, r = 0.78, p < 0.001; arterioles, r = 0.52, p < 0.001; venules, r = 0.45, p < 0.001). This study demonstrated that there is the significant locoregional distributional imbalance of the intramural-vessels between the proximal and distal parts of 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, the locoregional distributional imbalance of the intramural-vessels may lead to the ischemia of the anastomotic site of the EBD.