Clinical Research
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 28, 2006; 12(36): 5820-5825
Published online Sep 28, 2006. doi: 10.3748/wjg.v12.i36.5820
Adult-to-adult right lobe living donor liver transplantation: Comparison of endoscopic retrograde cholangiography with standard T2-weighted magnetic resonance cholangiography for evaluation of donor biliary anatomy
Perdita Wietzke-Braun, Felix Braun, Dieter Müller, Thomas Lorf, Burckhardt Ringe, Giuliano Ramadori
Perdita Wietzke-Braun, Giuliano Ramadori, Abteilung für Gastroenterologie und Endokrinologie, Georg-August-Universität, Göttingen, Germany
Felix Braun, Klinik für Allgemeine Chirurgie und Thorax-chirurgie, Universität Schleswig-Holstein, Campus Kiel, Germany
Dieter Müller, Abteilung für Diagnostische Radiologie, Georg-August-Universität, Göttingen, Germany
Thomas Lorf, Klinik für Allgemeine Chirurgie, Georg-August-Universität, Göttingen, Germany
Burckhardt Ringe, Center for Liver, Pancreas and Biliary Disease, Drexel University College of Medicine, Philadelphia, United States
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Giuliano Ramadori, Professor, HC Klinik für Gastroenterologie und Endokrinologie, Innere Medizin, Georg-August-Universität, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany. gramado@med.uni-goettingen.de
Telephone: +49-551-396301 Fax: +49-551-396921
Received: March 22, 2006
Revised: July 10, 2006
Accepted: July 18, 2006
Published online: September 28, 2006
Abstract

AIM: To compare the value of endoscopic retrograde cholangiography (ERC) and standard T2-weighted magnetic resonance cholangiography (MRC) in the evaluation process as adult-to-adult right lobe living donor liver transplantation (LDLTx) demands a successful outcome, and exact knowledge of the biliary tree is implicated to avoid biliary complications, postoperatively.

METHODS: After starting the LDLTx program, 18 liver transplant candidates were selected for LDLTx by a stepwise evaluation process. ERC and standard T2-weighted MRC were performed to evaluate the biliary system of the donor liver. The anatomical findings of ERC and MRC mapping were compared using the Ohkubo classification.

RESULTS: ERC allowed mapping of the whole biliary system in 15/15 (100%) cases, including 14/15 (93.3%) with biliary variants while routine MRC was only accurate in 2/13 (15.4%) cases. MRC was limited in depicting the biliary system proximal of the hepatic bifurcation. Postoperative biliary complications occurred in 2 donors and 8 recipients. Biliary complications were associated with Ohkubo type C, E or G in 6/8 recipients, and 2/3 recipients with biliary leak received a graft with multiple (≥2) bile ducts.

CONCLUSION: Pretransplant ERC is safe and superior over standard MRC for detection of biliary variations that occur with a high frequency. However, precise knowledge of biliary variants did not reduce the incidence of postoperative biliary complications.

Keywords: Living donor liver transplantation; Donors biliary tree; Endoscopic retrograde cholangiography; Magnetic resonance cholangiography