Role of MR Cholangiography in Evaluation of Hepatic Biliary Morphology in Living Liver Donors

Purpose: To assess the utility of magnetic resonance cholangiopancreatography (MRCP) in preoperative mapping of biliary anatomy in adult-to-adult living donor liver transplantation LDLT). Materials and Methods: Fifty LDLT donors (39 males and 11 females) their age 20-37 years (mean age 20.8 years) referred from liver transplantation surgeons to radiology Departments at Dar Al Fouad Hospital for doing preoperative MRCP during the period from April 2009 to March 2011. Intraoperative cholangiography (IOC) was used as the reference standard. The MRCP was performed on 1.5 Testa MR magnets using respiratory triggering techniques T2-weighted sequences in axial/coronal thin sections, and variable-thickness rotating slabs. The accuracy of preoperative MRCP for biliary mapping in potential LDLT donors was analyzed compared to the IOC findings. Results: Of the 50 donors, MRCP showed only 12 (24%) had type K1 anatomy (classical branching patterns of the biliary system). The remaining 38 subjects had anatomical variants: 17 (34%) had type K2a, 3 (6%) had type K2b, 10 (20%) had type K3a, 4 (8%) had type K3b, 2 (4%) had type K4 and 2 (4%) had unclassified pattern (type K6). Compared with IOC findings as the reference standard in our study, MRCP correlated with IOC in 48 (98%) of 50 subjects. Conclusion: Preoperative MRCP accurately depicts the biliary anatomy and variants in LDLT donors and should be used in the preoperative workup of all donors, to allow exclusion of unsuitable donors, thus ensuring donor safety and optimal recipient outcome.