Preoperative MRCP versus Intraoperative Cholangiography in Bile Ducts imaging in Living Donor Liver Transplantation

Abbas, Mareha Mohammed; Korayem, Enas Mohamed; Abdel-Gawad, Mohamed Saied; Fayed, Yehia; Magdy, Muhammed Ahmed

doi:10.21608/ijma.2025.351143.2097

Preoperative MRCP versus Intraoperative Cholangiography in Bile Ducts imaging in Living Donor Liver Transplantation

Document Type : Original Article

Authors

¹ Department of Diagnostic and Interventional Radiology, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt.

² Department Pancreaticobiliary Surgery, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt.

10.21608/ijma.2025.351143.2097

Abstract

Background: Anatomical variability in the biliary system can influence the choice of transection plane for the right hepatic duct during donor hepatectomy. To address this, preoperative and intraoperative biliary imaging plays a crucial role.
Aim of the work: This study aims to assess the efficacy of Magnetic Resonance Cholangiopancreatography [MRCP] in mapping the biliary anatomy of adult-to-adult living related liver transplant [LRLT] donors, and to compare its results with those from intraoperative cholangiograms [IOCs].
Patients and methods: This prospective study included 20 adult patients undergoing Living-Donor Liver Transplantation [LDLT] at the surgical and radiology department of Menoufia University's National Liver Institute. All donors underwent preoperative biliary mapping using 3D MRCP, along with other advanced imaging techniques, as part of the preoperative evaluation.
Results: Among the 20 donors, 75% [15/20] had normal biliary anatomy [Type 1], while 25% [5/20] exhibited anatomical variations. The variations included Type 3B [10%, 2/20], Type 3A [5%, 1/20], and Type 2 [5%, 1/20]. When compared with IOC, MRCP demonstrated 100% sensitivity, specificity, and accuracy in identifying normal biliary anatomy. For the overall data, MRCP showed 80% sensitivity, 100% specificity, 94% positive predictive value, 95% negative predictive value, and 95% accuracy. The agreement between MRCP and IOC was strong [Kappa = 0.857, P < 0.001].
Conclusion: MRCP is a highly accurate and reliable non-invasive tool for preoperative biliary mapping in living liver donors. It is particularly effective in identifying normal biliary anatomy, making it an essential component in donor selection and surgical planning.

Keywords