Use of Imaging for Living Donor Liver Transplantation

Abstract

Living donor liver transplantation is emerging as an alternative to cadaveric liver transplantation. The authors present multimodality images obtained in 44 cases of living donor liver transplantation. The images in this article were derived from the pre-, intra-, and postoperative imaging protocol for their institutional transplantation program. Preoperative magnetic resonance (MR) imaging in the donor allows detection of focal liver lesions and accurate determination of liver volume. The latter is crucial to ensure adequate postoperative liver function for donors and recipients. MR cholangiography depicts donor biliary anatomy. MR angiography and digital subtraction arteriography are performed to assess vascular anatomy. Intraoperative ultrasonography (US) helps determine the resection plane during donor hepatectomy. Postoperative MR imaging documents liver regrowth. MR imaging, US, and computed tomography help assess complications in donors and recipients.

Functional venous anatomy for right-lobe grafting and techniques to optimize outflow

“…23 Although it is not necessary to visualize the transection plane preoperatively, a relatively precise estimate of graft mass is essential. A 2-cm discrepancy between radiographic and surgical points of bipartition could represent a difference of as much as 200 g. The inflow-oriented plane is almost always to the right of the radiographic plane; therefore, imaging studies are likely to overestimate graft mass.…”

Living donor liver transplantation: Summary of a conference at The National Institutes of Health

“…Many groups accomplish this goal by imaging the hepatic venous system during the donor evaluation with either magnetic resonance angiography, three-dimensional CT, or a hepatic arteriogram. [51][52][53]73,77,78 During donor hepatectomy, many groups also use intraoperative ultrasound to clearly identify the middle hepatic vein as it courses through segment 4. As noted, the plane of resection is typically placed just to the right of this vascular structure (Fig.…”

“…However, in many cases, variants of this normal biliary ductal system are present. 70,71,73,75,77 The most common of these variants is a bifurcation or trifurcation of the right hepatic duct, which occurs in approximately 33% of cases. A posterior accessory right duct originating from the left bile duct can be found in another 15% of donors.…”

“…Ultrasound and Doppler, MRI, magnetic resonance angiography and/or cholangiography, and CT have been used for these purposes at various centers. [51][52][53][54][55]61,77,78 The final phase of the evaluation is devoted to invasive procedures required to investigate potential problems or medical conditions discovered during phases 1 and 2. This is typically limited, but may include liver biopsy to assess hepatic steatosis, hepatic angiography to define arterial and venous drainage, endoscopic retrograde cholangiopancreatography (ERCP) to define biliary tract anatomy, or additional consultations and procedures.…”

O papel da colangiografia por ressonância magnética na avaliação da anatomia biliar em doadores de transplante hepático intervivos

“…Living-donor liver transplant is a definite method of treatment introduced for minimizing this problem (2) . Particular care utilization of magnetic resonance imaging as the method of choice for preoperative evaluation of the biliary anatomy (2,6-8) and also as a sole method for preoperative evaluation in these cases, considering its accuracy in the detection of hepatic parenchyma abnormalities hepatic and lobar volume, besides the depiction of the portal artery, and of the venous and biliary systems anatomy (9)(10)(11) .…”