Impact of Multislice Spiral Computed Tomography on Donor Selection and Surgical Planning in Living-Related Liver Transplant

Abstract

Objectives: Living-donor liver transplant is used with increasing frequency to help compensate for the increasing shortage of deceased-donor liver grafts. However, donor safety is a primary concern, and selection of the preoperative imaging modality is important in preserving donor’s health by excluding unsuitable candidates, and tailoring the surgical procedure according to anatomic variations.

In this study, we evaluate the impact of multislice spiral computed tomography on potential donor selection and surgical planning before living-related liver transplant.

Materials and Methods: One-hundred seventy-five potential living-liver donors (62 women and 113 men; age range, 23-34 years; mean, 32 years) were included in our study. All subjects underwent multiphasic multislice spiral computed tomography. Postcontrast acquisitions were obtained for the arterial and venous phases. There were 139 potential donors for the right lobe and 36 potential donors for the left lateral segment. All data were analyzed to detect vascular variants, exclude focal liver lesions, and determine hepatic volume, and preoperative findings were correlated with intraoperative findings in 65 patients.

Results: Of the 175 potential liver donors evaluated with multislice spiral computed tomography, 56 (32%) were excluded for the following reasons: portal vein anomalies in 11 (19.6%), hepatic venous anomalies in 9 (16.1%), fatty liver in 17 (30.3%), small liver volume in 12 (21.4%), and a focal lesion in the liver in 7 (12.5%). Of the 65 candidates, surgical planning and technique were modified in 24 donors and recipients, in 23 candidates, and the donor only in 1 candidate.

Conclusions: Multislice spiral computed tomography provides parenchymal, vascular, and volumetric preoperative evaluation of potential donors for living-related liver transplant and has an effect on surgical planning: It allows the surgeon to reduce postoperative complications by modifying the surgical technique.