Application of MRCP in the preoperative biliary assessment of donors before adult living donor liver transplantation using right lobe graft

Abstract

Objective To investigate the clinical application of the distance of biliary duct measured by MRCP in bile duct resection of the donor and biliary reconstruction of recipients in living donor liver transplantation (LDLT) using right lobe graft.Methods Seventy-six living donors received preoperative MRCP after fat meal,who underwent right lobe resection and all had intraoperative cholangiography (IOC) for comparison.The accuracy of preoperative MRCP for biliary types in LDLT donors was analyzed and compared to that of IOC findings.The length of biliary duct between the junction of the right posterior hepatic duct (RPHD) and the junction of the right and left hepatic ducts was measured in MRCP images.The reconstruction of intraoperative data and the length,the diameter were compared,and binary logistic regression and Receiver Operating Characteristic (ROC) curves were calculated.The result included the limitation.Results In comparison to IOC,the accuracy of MRCP after fat meal was 97.4 ％.The length of biliary duct between the junction of RPHD and the junction of the right and left hepatic ducts measured by MRCP and the biliary type were the influencing factor of intraoperative reconstruction of biliary duct; while the diameter of biliary duct had no influence ROC curves showed that when the length of biliary duct of type Ⅰ was smaller or equal to 4.2 mm,or the biliary anatomy had variation,the number of biliary anastomotic stomas was more than one,and plasty was selected in 95 ％ of donors intraoperatively.The corresponding length of biliary duct of type Ⅲ and type Ⅳ was 3.8 mm,which was the limitation whether biliary plasty was done intraoperatively.Conclusion The type of bile duct in MRCP can reflect the biliary anatomy structure accurately.The length of biliary duct between the junction of RPHD and the junction of the right and left hepatic ducts measured by MRCP after fat meal can guide the biliary reconstruction intraoperatively and offer reliable basis for optimizing the clinical operation program in adult LDLT. Key words: Liver transplantation; Living donors; Cholangiopancreatography, magnetic resonance; Biliary reconstruction