Journal of Liver Transplantation最新文献

{"title":"Deep learning technique for automatic liver and liver tumor segmentation in CT images","authors":"Gowda N Yashaswini ,&nbsp;R.V. Manjunath ,&nbsp;B Shubha ,&nbsp;Punya Prabha ,&nbsp;N Aishwarya ,&nbsp;H M Manu","doi":"10.1016/j.liver.2024.100251","DOIUrl":"10.1016/j.liver.2024.100251","url":null,"abstract":"<div><div>Segmenting the liver and tumors from computed tomography (CT) scans is crucial for medical studies utilizing machine and deep learning techniques. Semantic segmentation, a critical step in this process, is accomplished effectively using fully convolutional neural networks (CNNs). Most Popular networks like UNet and ResUNet leverage diverse resolution features through meticulous planning of convolutional layers and skip connections. This study introduces an automated system employing different convolutional layers that automatically extract features and preserve the spatial information of each feature. In this study, we employed both UNet and a modified Residual UNet on the 3Dircadb (3D Image Reconstruction for computer Assisted Diagnosis database) dataset to segment the liver and tumor. The ResUNet model achieved remarkable results with a Dice Similarity Coefficient of <strong>91.44%</strong> for liver segmentation and <strong>75.84%</strong> for tumor segmentation on 128 × 128 pixel images. These findings validate the effectiveness of the developed models. Notably both models exhibited excellent performance in tumor segmentation. The primary goal of this paper is to utilize deep learning algorithms for liver and tumor segmentation, assessing the model using metrics such as the Dice Similarity Coefficient, accuracy, and precision.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100251"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of peroral cholangioscopy in liver transplant recipients: A prospective, international series","authors":"Tomazo Franzini ,&nbsp;Eduardo G.H. De Moura ,&nbsp;Andres Cardenas ,&nbsp;Adam Slivka ,&nbsp;Jan-Werner Poley ,&nbsp;Georgios I. Papachristou ,&nbsp;Mordechai Rabinovitz ,&nbsp;Marco Bruno ,&nbsp;Joyce A. Peetermans ,&nbsp;Matthew J. Rousseau ,&nbsp;Wellington Andraus ,&nbsp;Jean C. Emond ,&nbsp;Amrita Sethi","doi":"10.1016/j.liver.2025.100259","DOIUrl":"10.1016/j.liver.2025.100259","url":null,"abstract":"<div><h3>Background</h3><div>Biliary strictures are a common complication of living and deceased donor liver transplantation. Peroral cholangioscopy (POCS) with POCS-guided biliary tract biopsies may improve diagnostic accuracy compared to endoscopic retrograde cholangiopancreatography (ERCP) with biopsy, but the role and clinical impact of adding POCS to ERCP in management of post-liver-transplantation biliary adverse events remains unknown.</div></div><div><h3>Methods</h3><div>In a multicenter prospective study, patients ≥1 month post-liver transplantation with abnormal imaging and/or liver tests, without prior treatment of a biliary stricture, and referred for ERCP evaluation of a suspected biliary stricture underwent POCS immediately following the initial diagnostic portion of the ERCP. Outcomes were POCS visual impression of the stricture, impact on patient management and diagnosis, and related serious adverse events (SAEs).</div></div><div><h3>Results</h3><div>Forty-one patients (88 % cadaveric donors, mean 28 ± 44 months since liver transplantation) underwent POCS (mean POCS procedure time 25.7 ± 19.5 min). Stricture was confirmed by POCS in 38 patients (93 %) treated with balloon dilation (2), biliary stent(s) (7) or both (28), or with percutaneous drainage (1). Three patients without POCS-confirmed stricture had an angulated duct (2) or a cast (1). POCS influenced patient management in 26 (63 %), and diagnosis in 19 patients (46 %). POCS-guided selective guidewire placement was achieved in 12 cases (29 %) that failed during ERCP. No POCS-related SAEs were reported.</div></div><div><h3>Conclusions</h3><div>When added to standard-of-care ERCP, POCS showed diagnostic value and helped change patient management in over 60 % of patients, with no POCS-related adverse events. The greatest impact was in visual enhancement and facilitating guidewire access to the donor ducts.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100259"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunotherapy in liver transplantation for hepatocellular carcinoma: A comprehensive review","authors":"Miho Akabane ,&nbsp;Yuki Imaoka ,&nbsp;Jun Kawashima ,&nbsp;Austin Schenk ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.liver.2024.100256","DOIUrl":"10.1016/j.liver.2024.100256","url":null,"abstract":"<div><div>Immunotherapy has emerged as an important approach in the treatment of hepatocellular carcinoma (HCC), particularly through the use of immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 and CTLA-4 pathways. While this therapy offers new hope for patients, it presents unique challenges when integrated with liver transplantation (LT), the definitive treatment for early-stage HCC. Despite LT's curative potential, post-transplant tumor recurrence remains a concern, partly due to the immunosuppressive regimens necessary to prevent graft rejection, which can impair immune surveillance and increase the risk of HCC recurrence and de novo malignancies. Incorporating immunotherapy offers a strategy to enhance antitumor immunity but raises concerns about triggering graft rejection due to immune activation. Nevertheless, the use of ICIs as neoadjuvant therapy before LT has demonstrated promise in downstaging tumors and reducing waitlist dropout rates; however, careful patient selection, optimal timing between ICI administration and LT, and tailored immunosuppressive management are crucial to mitigate the risk of acute graft rejection. In the post-LT setting, ICIs have been examined for treating recurrent HCC, with some data demonstrating promising antitumor responses. Nonetheless, the risk of severe rejection unresponsive to standard immunosuppressive therapies necessitates cautious application and close monitoring. Furthermore, emerging immuno-cell therapies, such as natural killer (NK) cell-based treatments, offer robust antitumor activity with potentially fewer adverse effects compared with T-cell-based therapies. These innovative approaches are under investigation for their ability to enhance immune surveillance and reduce HCC recurrence post-LT. Integrating immunotherapy into the management of HCC among LT recipients holds promise but requires a delicate balance between maximizing antitumor efficacy and minimizing the risk of graft rejection. Future research should focus on establishing standardized protocols for the safe incorporation of immunotherapy in LT patients, optimizing immunosuppressive regimens, and further exploring the potential of immuno-cell therapies to improve long-term outcomes for HCC patients undergoing LT.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100256"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automatic liver tumor classification using UNet70 a deep learning model","authors":"Yashaswini Gowda N ,&nbsp;Manjunath R V","doi":"10.1016/j.liver.2025.100260","DOIUrl":"10.1016/j.liver.2025.100260","url":null,"abstract":"<div><div>Diagnosing liver diseases using computed tomography (CT) images can be challenging even for experienced radiologists due to the complexities involved in evaluating the liver. Accurately determining the type, size and severity of tumors is often difficult. In recent years there has been a growing need for computer-assisted imaging techniques to aid in liver disease diagnosis ultimately improving clinical outcomes which in turn improves the life span of patients by early detection of the disease and treatment. This paper presents an innovative deep learning model UNet70 for liver tumor classification where CT images are categorized as either having a tumor (hepatocellular and Metastatic) or not. Our results show that the proposed model excels in terms of accuracy, sensitivity and dice score compared to other established algorithms and demonstrates excellent adaptability across various datasets. With an accuracy of 94.58 %, dice score of 94.73 % and sensitivity of 97.50 % the model outperforms existing methods showcasing its effectiveness.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100260"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143220291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of bridge therapy for hepatocellular carcinoma in patients submitted to liver transplantation: A Brazilian multicenter study","authors":"Julia Fadini Margon ,&nbsp;Aline Lopes Chagas ,&nbsp;Angelo A. Mattos ,&nbsp;Márcio A. Diniz ,&nbsp;Guilherme E.G. Felga ,&nbsp;Ilka F.S.F. Boin ,&nbsp;Renato Ferreira da Silva ,&nbsp;José Huygens Parente Garcia ,&nbsp;Agnaldo Soares Lima ,&nbsp;Rita C.M.A. da Silva ,&nbsp;Paulo Everton Garcia Costa ,&nbsp;Maria Lúcia Zanotelli ,&nbsp;Júlio Cezar Uili Coelho ,&nbsp;André L.C. Watanabe ,&nbsp;Débora Raquel Terrabuio ,&nbsp;Paulo Roberto Reichert ,&nbsp;Paulo Lisboa Bittencourt ,&nbsp;Leila M.M. Beltrão Pereira ,&nbsp;Luiz Augusto Carneiro-D'Albuquerque ,&nbsp;Flair José Carrilho","doi":"10.1016/j.liver.2025.100258","DOIUrl":"10.1016/j.liver.2025.100258","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Hepatocellular carcinoma (HCC) is a main indication for liver transplantation (LT). Bridge therapy (BT) is recommended when waiting time on transplant list is longer than 6 months to prevent dropout. However, the prognostic role of locoregional treatment in post-LT outcomes needs to be better defined. Our aims were to evaluate the impact of BT on post-LT overall survival (OS) and recurrence-free survival (RFS) among LT recipients with HCC.</div></div><div><h3>Materials and Methods</h3><div>Multicenter retrospective cohort study in HCC patients submitted to LT with clinical and radiological data analysis. Clinical features, BT and tumor response according to mRECIST were analyzed. Post-LT OS and RFS according to this were compared.</div></div><div><h3>Results</h3><div>1,119 patients were included. Waiting time on transplant list was longer than 6 months in 49 % of patients and 67 % underwent BT. Transarterial-chemoembolization/embolization were the most common treatments performed (80 %). According to mRECIST, 37 % showed complete response (CR), 38 % partial response (PR), 12 % stable disease (SD) and 13 % progressive disease (PD). The OS was 63 % in 5y in a mean follow-up of 28 months. Post-LT tumor recurrence was 8 %. There were no differences in RFS or OS among patients who underwent or not BT. However, patients who achieved CR had a higher RFS compared to PR, SD or PD (<em>p</em> = 0.019) and the objective response to treatment was an independent predictor of lower recurrence risk.</div></div><div><h3>Conclusions</h3><div>In a large multicentric cohort of LT recipients we observed that patients that achieved CR after BT presented lower risk of post-LT tumor recurrence.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100258"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical refinements to reduce the early biliary complication in living donor liver transplantation","authors":"Tsan-Shiun Lin ,&nbsp;Yeong-Sing Lee ,&nbsp;Khee-Ghee Tan ,&nbsp;Stephen Matthew B. Santos ,&nbsp;Chih-Che Lin ,&nbsp;Shih-Ho Wang ,&nbsp;Chee-Chien Yong ,&nbsp;Wei-Feng Li ,&nbsp;Yu-Fan Cheng ,&nbsp;Chih-Chi Wang ,&nbsp;Chao-Long Chen","doi":"10.1016/j.liver.2024.100241","DOIUrl":"10.1016/j.liver.2024.100241","url":null,"abstract":"<div><h3>Background</h3><div>Biliary reconstruction is a key factor that affects biliary complication rates. Surgical experience plays a pivotal role, but continuous technical refinement is essential for enhancing biliary outcomes. This study aimed to evaluate the biliary outcomes of LDLTs in patients undergoing microsurgical biliary reconstruction with continual technical refinements.</div></div><div><h3>Materials and Methods</h3><div>This observational cohort study analyzed data was conducted from 2006 to 2022. Microsurgical biliary reconstruction was performed using various refinements, including selective biliary stent insertion, ipsilateral (anatomical) bile duct anastomosis, use of a figure-of-8 suture over the junction of the graft and recipient bile ducts, and centralization techniques for size discrepancies greater than 2 to 1. Comparison and evaluation of early BC within one year post transplant was performed.</div></div><div><h3>Results</h3><div>1780 patients (including 1563 adults and 217 paediatric patients) underwent microsurgical biliary reconstruction in LDLTs at KCGMH between 2006 and 2022. The donor grafts comprised 1109 right liver grafts and 671 left liver grafts. Of the grafts, 23.1 % had multiple bile ducts and 16.1 % had bile duct sizes &lt;3 mm. Duct-to-duct anastomosis was performed in most cases 1417 (79.6 %), while 363 (20.4 %) Roux-en-Y hepaticojejunostomies (RY HJ) was performed. The overall early BCs rate was 10 % and notable improvements were observed, decreasing from 10.35 % between 2006 and 2021 to 6.5 % by 2022. Early BS comprised the most part of 6.1 % as compared to 2.7 % one year after transplantation. Stent insertion in selected cases, ipsilateral anastomosis, and the figure-of-8 suture technique significantly reduced early BCs. Although centralization technique showed promising results, its effect was not statistically significant.</div></div><div><h3>Conclusions</h3><div>Continual technical refinements in MBR can contribute to a substantial reduction in early BCs following LDLT, ultimately leading to improved patient outcomes.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100241"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daratumumab as a rescue therapy for antibody-mediated rejection in super-urgent ABO-incompatible pediatric liver transplantation","authors":"Zeynep Demir ,&nbsp;Jean Paul Duong Van Huyen ,&nbsp;Carmen Capito ,&nbsp;Julien Zuber ,&nbsp;Aline Floch ,&nbsp;Muriel Girard ,&nbsp;Dominique Debray","doi":"10.1016/j.liver.2024.100245","DOIUrl":"10.1016/j.liver.2024.100245","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100245"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of underlying inflammatory bowel disease on the outcomes of primary sclerosing cholangitis liver transplant recipients","authors":"Mausam J. Patel ,&nbsp;Bill Y. Zhang ,&nbsp;Thomas G. Cotter ,&nbsp;Ahmad Anouti","doi":"10.1016/j.liver.2024.100244","DOIUrl":"10.1016/j.liver.2024.100244","url":null,"abstract":"<div><h3>Introduction</h3><div>Inflammatory bowel disease (IBD) influences primary sclerosing cholangitis (PSC) severity, however, the impact of IBD on PSC liver transplantation (LT) outcomes is poorly understood. We aimed to elucidate the impact of IBD in modulating PSC LT outcomes.</div></div><div><h3>Methods</h3><div>Using UNOS data from 2010 through 2021, we identified PSC LT candidates with and without (±) IBD. We used adjusted competing-risk regression analysis to evaluate waitlist outcomes, Kaplan-Meier analysis to assess graft survival, and Cox proportional hazards modeling to identify factors associated with graft survival.</div></div><div><h3>Results</h3><div>Out of 5,586 PSC candidates added to the waitlist, 3,652 patients had IBD. Older age (SHR 1.01; 95 %CI 1.01–1.02) and initial MELD/PELD (SHR 1.03; 95 %CI 1.02–1.04) were associated with increased risk of waitlist mortality, while private insurance (SHR 0.00; 95 %CI 0.00–0.01) with reduced risk. PSC-IBD LT recipients had increased prevalence of cholangiocarcinoma (4.8 % vs 3.4 %, p=0.005). Longer donor cold ischemia times (HR 1.06; 95 %CI 1.03–1.09), presence of recipient diabetes (HR 1.52; 95 %CI 1.13–2.05), and employment (HR 0.75, 95 %CI 0.60–0.94) had an increased risk of graft failure among PSC patients with IBD, not seen in those without IBD.</div></div><div><h3>Conclusion</h3><div>Regardless of IBD, LT for PSC results in excellent outcomes. Certain clinicodemographic factors impacted waitlist and recipient mortality highlighting potential targets to enhance outcomes.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100244"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biodegradable internal biliary stenting in orthotopic liver transplantation – A feasibility study","authors":"Nicholas Dalkie ,&nbsp;Jonathan Ng ,&nbsp;Peter Lim ,&nbsp;Eunice Lee ,&nbsp;Ruelan Furtado ,&nbsp;Robert Jones ,&nbsp;Rhys Vaughan ,&nbsp;Marios Efthymiou ,&nbsp;Sujievvan Chandran ,&nbsp;Marcos V. Perini","doi":"10.1016/j.liver.2024.100242","DOIUrl":"10.1016/j.liver.2024.100242","url":null,"abstract":"<div><h3>Introduction</h3><div>Biliary complications remain a common cause of morbidity after liver transplantation and often require invasive interventions to manage. We aimed to assess the technical feasibility and safety of placement of a biodegradable stent across the biliary anastomosis at the time of liver transplantation in patients having a duct to duct biliary reconstruction.</div></div><div><h3>Methods</h3><div>For this prospective, single-arm, descriptive study, 10 consecutive patients undergoing whole graft, deceased donor, liver transplantation and duct-to-duct biliary tract reconstruction were enrolled and a biodegradable biliary stent was sutured into the bile duct across the anastomosis.</div></div><div><h3>Results</h3><div>In all 10 patients it was technically feasible to place and secure the stent safely during the operation. After &gt;6 months (median of 212 days) follow up, no patients had developed biliary anastomotic stricture. One patient had transient bile leak immediately post-operative that was managed conservatively. One patient required endoscopic intervention for non-anastomotic stricture development and biliary cast material that had resulted in stent dysfunction.</div></div><div><h3>Discussion</h3><div>The results of this study suggest surgical feasibility of placement of an absorbable biliary stent across the biliary anastomosis at the time of liver transplantation, as well as an acceptable safety profile. Further studies are required to confirm these safety and feasibility findings and to assess efficacy in reducing rates of biliary complications and the need for endoscopic intervention in the early post-transplant period.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100242"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early duct division in type D Portal Vein anatomy for safe donor hepatectomy-a novel technique","authors":"Sreekumar Sreejith ,&nbsp;Shaleen Agarwal ,&nbsp;Abhishek Agarwal ,&nbsp;Ruchi Rastogi ,&nbsp;Utkarsh Shah ,&nbsp;Aman Chopra ,&nbsp;Peush Sahni ,&nbsp;Subhash Gupta","doi":"10.1016/j.liver.2024.100243","DOIUrl":"10.1016/j.liver.2024.100243","url":null,"abstract":"<div><div>Complex portal venous anatomy encountered in adult living donor liver transplantation poses significant technical challenges, primarily concerning donor safety. This complexity necessitates meticulous and time-consuming backbench reconstruction, rendering it a relative contraindication for donation. Advancements in surgical expertise have enabled successful resolution of many of these intricate anatomical challenges. We report a complex type-D portal vein along with type IIIB biliary anatomy in donor during adult living donor liver transplantation, which was tackled by completing the parenchymal transection and dividing the hepatic ducts before the right anterior portal vein could be delineated. The main portal vein, right posterior portal vein and left portal vein were delineated and the transection line was marked after clamping main portal vein and right hepatic artery. The final delineation of portal venous anatomy with looping of the right anterior portal vein was done after completion of parenchymal transection and division of right anterior and posterior sectoral ducts. During the backbench preparation, right anterior and posterior portal vein were anastomosed to a Y-graft obtained from the recipient explant portal vein to create a single portal inflow orifice. Post-operatively, both the donor and recipient recovered well. In exceptional circumstances, consideration of donors with type-D portal vein becomes viable where the surgical expertise is available.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100243"},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}