Stratifying risk of biliary complications in adult living donor liver transplantation by magnetic resonance cholangiography.
BACKGROUND
Accurate preoperative assessment of biliary anatomy in live donor hepatectomy may be helpful to assess the suitability of a graft and to stratify risk of biliary complications.


METHODS
A retrospective review of existing data among donor and recipients of 36 living donor transplants was performed to assess role of preoperative magnetic resonance cholangiography (MRC) for defining biliary anatomy and to stratify risk of biliary complications.


RESULTS
Thirty-six living liver donors underwent MRC, and subsequently right lobectomy. Intraoperative cholangiography and biliary exploration revealed that 24 donors (66.6%) had conventional and 12 (33.3%) had aberrant biliary anatomy. Intraoperative cholangiography demonstrated a strong correlation with MRC (P=0.001) and intraoperative findings (P=0.001). MRC had specificity and positive predictive value of 100%. The risk of developing biliary complication was 5.9 times higher if the biliary anatomy was of any type other than A (P=0.03, CI 1.06-32.9) after controlling for donor age, recipient age, and type of anastomosis.


CONCLUSIONS
MRC reliably identified variant biliary anatomy. The preoperative MRC demonstrated congruence with the intraoperative cholangiogram and with the intraoperative findings. MRC is helpful in predicting risk of biliary complications in recipients, and identifies donors who would otherwise be excluded intraoperatively by cholangiography, thus limiting the risk of an unnecessary operation.
Kashyap
Randeep
R
Division of Transplantation, Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642-8410, USA. randeep_kashyap@urmc.rochester.edu
Bozorgzadeh
Adel
A
Abt
Peter
P
Tsoulfas
Georgios
G
Maloo
Manoj
M
Sharma
Rajeev
R
Patel
Siddharth
S
Dombroski
David
D
Mantry
Parvez
P
Safadjou
Saman
S
Jain
Ashok
A
Orloff
Mark
M
D000328:Adult; D000714:Anastomosis, Surgical; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D001652:Bile Ducts / Q000601:surgery; D001659:Biliary Tract / Q000033:anatomy & histology*; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020858:Tissue and Organ Harvesting / Q000379:methods*