Anatomical Evaluation of the Biliary System of Living Liver Donors using Pre-Operative Non-Enhanced MRCP in Comparison to Intra-Operative Cholangiogram

Background: Accurate preoperative evaluation of biliary anatomy is crucial for the safety and success of living donor liver transplantation (LDLT). MRCP, a non-invasive imaging technique, is widely used to identify biliary variations and anomalies in potential donors. This study aims to evaluate the effectiveness of non-enhanced MRCP in detecting biliary tree variations in living liver donors compared to intra-operative cholangiography (IOC). Methods: This prospective study was conducted on 50 potential liver donors (28 males, 22 females, aged 18-45 years) at Mansoura University, Gastro-Intestinal Center, Liver Transplantation Unit from August 2022 to August 2024. All donors underwent preoperative MRCP followed by IOC during surgery. MRCP findings were compared with IOC, the gold standard, to determine sensitivity, specificity, and accuracy. Results: MRCP correctly identified variant biliary anatomy in 46 of 50 donors. The most common variant was RPSD draining into the right hepatic duct (44%). MRCP showed a sensitivity of 91.3%, specificity of 100%, and overall accuracy of 95.7% compared to IOC, which provided additional details in 5 cases missed by MRCP. Conclusion: MRCP is a highly sensitive and specific non-invasive technique for preoperative biliary anatomy assessment in LDLT donors. It enables safer surgeries and reduces postoperative complications by accurately identifying biliary variants, though IOC may still reveal additional crucial details.