الفهرس 
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Abstract
Living donor liver transplantation (LDLT) has become a widely accepted treatment option for end-stage liver disease (ESLD). Biliary complications still considered the Achilles’ heel of living donor liver transplantation (LDLT), with recorded complication rates for right lobe LDLT as high as 20–34 %. The etiology for the high incidence of biliary complications in LDLT is not well defined, but may be related to the size and number of donor allograft bile ducts, as well as the vascular supply of both donor and recipient bile ducts.
Duct to duct anastomosis should be performed with a well-preserved peri-choledochal vasculature to reduce post-transplant biliary complication occurrences. Biliary complication may be the result of bile duct devascularization during a hilar dissection, a bile duct injury by failure to recognize a biliary anatomy, or a challenging anastomosis of small and/or multiple ducts.
Hepatic arterial reconstruction plays a more important role in duct-to-duct anastomosis than in hepaticojejunostomy after liver transplantation because the arterial blood supply to the anastomosis site and graft bile duct in duct-to-duct anastomosis originates only from the reconstructed HA, while that in hepaticojejunostomy originates not only from the reconstructed HA but also from the collateral arteries that originate from many jejunal arteries.
The High Hilar Dissection technique during the recipient hepatectomy, may reduce the incidence of biliary complications, presumably by preserving the biliary vascular supply. This technique preserves the right hepatic artery and the common bile duct in continuity during the dissection, thus protecting the biliary vascular supply
Anatomically, it seems more appropriate to use the recipient’s right hepatic artery (RHA) over the left hepatic artery (LHA) for arterial reconstruction in right lobe LDLT. The course of the recipient’s RHA usually runs just behind the common hepatic duct (CHD) and gives small nourishing branches to the biliary tree. Dissecting this tissue between the CHD and the RHA to increase the later flexibility can cause ischemia of the recipient’s extrahepatic bile duct and cause further biliary complication especially Biliary anastomosis stricture (BAS).
Our study is a prospective cohort study which was conducted at Liver Transplantation Unit in Air Forces Specialized Hospital, Cairo, Egypt, between July 2020 until the end of April 2022 including all patients underwent living donor liver transplantation (LDLT) with stentless duct-to-duct biliary reconstruction and divided into two group, group (A) includes 40 recipients who had LHA for arterial reconstruction compared to historical control group (B) of patients (40 recipients) underwent LDLT using right hepatic artery (RHA) for arterial reconstruction.
In our study we were analysing whether the use of recipient ‘s LHA as inflow in arterial reconstruction lower the risk of postoperative biliary complication in patients who underwent living donor Liver Transplantion or not.
We concluded that the use of either RHA or LHA in arterial reconstruction in right lobe LDLTs does not reduce the incidence of duct-to-duct biliary complications which is a multifactorial risk that need to be approached systematically to reduce all risk factors as number of graft ducts, ductoplasty, cold ischemia and as well as arterial reconstruction. In addition, further prospective multicentre studies are needed to definitively identify the multivariate risk factors and improve the outcome of these complications.