Comparison Between Pre-operative Radiologic Findings and the Actual Operative Findings of the Graft in Adult Living Donor Liver Transplantation

Abstract

BackgroundComputed tomography (CT) volumetry and magnetic resonance cholangiopancreatography (MRCP) are mandatory steps for the evaluation of potential donors in living donor liver transplantation. The aim of this study is to compare the preoperative CT volumetry and biliary orifices of the donor graft to the actual operative findings. MethodsBetween December 2013 and December 2017, 45 donors (27 men and 18 women) with a mean age of 27.3 years (range, 19-41 years) were evaluated preoperatively by CT volumetry and MRCP at the National Hepatology and Tropical Medicine Research Institute in Cairo, Egypt. Of the donors, 43 out of 45 underwent intraoperative cholangiography before and after bile duct division. The right hepatectomies for all donors, as well as the actual weight and apparent biliary orifices in the graft, were documented. ResultsThe mean estimated graft volume (EGV) preoperatively by CT volumetry was 894.9 ± 184.2 mL (range, 480-1687 mL), whereas the actual graft weight (AGW) intraoperatively after washout was 862.6 ± 124.4 g (range, 676-1110 g). The correlation coefficient between the EGV and AGW was significantly linear (Y = 0.96X, r2 = 0.72, slope: 0.96, P < .001). The accuracy of the MRCP in preoperative biliary mapping was 76.7% whereas the accuracy of the MRCP in predicting the number of graft biliary orifices was 74.4% compared with the intraoperative cholangiography (IOC), which was 95.3% (P < .001). ConclusionThe weight of the right lobe of the liver graft in living donor liver transplants (LDLTs) can be accurately predicted preoperatively by multiplying the EGV by 0.96. Also, the IOC is an essential technique for LDLT.