The Efficacy of Pre-transplant Radiologic Evaluation for Graft Volume and Anatomy in Living Donor Liver Transplantation

Purpose: For securing donor safety in living donor liver transplantation (LDLT), we must know the anatomy of hepatobiliary and vascular structures as well as donor-recipient hepatic volume profile. The purpose of this study was to ascertain the role of donor-recipient evaluation by using pre-operative radiologic studies. Methods: Prospective pre-operative analyses of 94 LDLT candidate pairs (74 recipients and 94 donors) were performed. Tomographic images were reconstructed by 3-dimensional images and used as a resource of calculation of liver volume profile and anatomic structure evaluation. Results: The percentage of anatomical variation in portal, hepatic vein, hepatic artery and bile duct were 20.2, 41.5, 21.3 and 33.0%, respectively. Among 94 cases, 52 (55.4%) potential donors were unacceptable for LDLT due to a various reasons. The leading cause of unacceptability of donor was anatomical variation (n=24, 25.5%) such as anatomical variation of middle hepatic vein drainage patterns (n=20, 21.3%). Too small residual volume of donor (n=17, 18.1%) and ``small-for-size`` (n=5, 5.3%) were also considered criticalcauses of unacceptable donor. Only 19 out of 94 cases underwent successful 128 living donor right hepatic lobe transplantation. Conclusion: Pre-transplant evaluations of liver volume and anatomic structure by using three-dimensional imaging study and computerized volume measurement system is useful for performing safe LDLT.ope