Enumerate the critical radiological findings that should be mentioned in pre-liver transplantation workup in the living donor and the recipient.
Discuss the importance of these findings in the surgical outcome.
Review the different related imaging findings.
Liver transplantation is considered the only curative treatment for patients with end stage liver disease (1) and a successful treatment for unresectable small hepatocellular carcinoma (HCC) (2).
Its outcome had greatly improved during the last years giving the advance of immunosuppressive treatments and surgical techniques (1).
The majority of transplanted livers are from cadaveric donors (3) while the remaining are from living donors who undergo partial hepatectomy for liver donation (left lateral segment or right lobe for pediatric or adult recipients respectively) (1).
Findings and procedure details
A- Living donor
Cross sectional liver imaging of the donor is mandatory before liver donation to detect any contraindication or finding that may modify the surgical approach.
the liver parenchyma should be carefully evaluated for incidental diffuse (mainly steatosis) or focal (benign/malignant) conditions and identification of anatomical variants (4) (5).
A-1-Liver volume calculation Fig. 1 :
Precise estimation of the donor’s liver volume is of paramount importance (4).
A minimal residual volume of 30%-40% is required to prevent small-for-size syndrome on the assumption that...
A multidisciplinary approach is essential in liver transplantation in order to achieve the best outcome,
with the radiologist playing a crucial role during the whole process.
Radiological pre-liver transplantation assessment is becoming a daily routine in many major medical centers.
Meticulous understanding of the surgical process,
its potential complications and contraindications is of paramount importance to the radiologist to adequately report pertinent information to the surgeon.
1- Pannu HK,
Liver transplantation: preoperative CT evaluation.
2- Mazzaferro V,
Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis.
New England Journal of Medicine.
1996 Mar 14;334(11):693-700.
3- United Network for Organ Sharing.
Public comment: policy and by-law proposals—proposed new UNOS policy 126.96.36.199 (liver transplant candidates with hepatocellular carcinoma).
Available at: http://www.unos.org.
Accessed January 2001....