1. Improving patient safety by performing comprehensive noncontrast MR screening in prospective living donor liver transplant (LDLT) surgery donors- looking beyond MRCP

Abstract

Background and Aims: In a conventional prospective LDLT donor workup process, a noncontrast CT scan is performed first to exclude any significant liver steatosis followed by contrast enhanced CT angiography for volumetric and vascular assessment. Subsequently, MRCP is performed to assess biliary anatomy. However, a significant proportion of donors are rejected on the basis of CT assessment. We tried to minimize this undue CT exposure to potential LDLT donors by identifying majority of the factors responsible for rejection by performing a comprehensive non contrast MR as the first examination, evaluating for liver steatosis, volumetry, venous and biliary anatomy and overall abdominal evaluation. We aim to assess feasibility and impact of using non contrast enhanced MRI and MRCP as a screening tool in prospective LDLT donors in minimizing donor rejection rate after performing contrast enhanced CT scan. Methods: Donor MRI screening included liver parenchymal assessment for steatosis, assessment of biliary anatomy, liver volumetric assessment for calculating GRWR and remnant volume, assessment of portal venous anatomy on bright blood sequence, assessment of hepatic venous anatomy and the counting the number of inferior accessory hepatic veins and screening for any apparent intrahepatic or extrahepatic abnormality in upper abdomen. Results: We could minimize the numbers of rejected donors after CECT evaluation, thereby saving undue exposure of radiation and CT contrast to donor. Besides identifying donors to be rejected, screening MR could also suggest some form of presurgical management in a small cohort of patients with intrahepatic or extrahepatic abdominal pathology eg. borderline high liver fat content, incidentally detected abdominal lymphadenopathy etc. Conclusions: This resulted in considerable cost saving by reducing the number of unnecessary CT scans as well as reduction in numbers of liver biopsies since MR fat quantification has been proved to be more robust technique compared to CT fat quantification. The authors have none to declare.