Three-Dimensional Computed Tomography-Magnetic Resonance Cholangiopancreatography Imaging Fusion for Computer-Assisted Surgery Planning in Full Graft Living Donor Liver Transplant: A Single Centre Experience.

Abstract

Objectives: Computed tomography and magnetic resonance cholangiopancreatography are core components of living donor liver transplant. Here, we described our 3-dimensional computed tomography-magnetic resonance cholangiopancreatography, fusion-derived computer-assisted surgical planning system to evaluate its usefulness in full graft living donor liver transplant.

Materials and methods: Among 17 consecutive full graft left living donor liver transplants, 14 were planned with the 3-dimensional computed tomography-magnetic resonance cholangiopancreatography computer-assisted surgical planning system. The system allowed us to estimate liver volume compliance, allowing for individualized graft size enlargement by means of virtual-to-real resection line modifications. Virtual graft hepatectomy obviated the need for intraope-rative cholangiography in 93% of cases.

Results: Graft and recipient survival rates were 82% and 77% at 1 year and 94% and 82% at 5 years, respectively. Small-for-size and high-risk small-for-size grafts constituted 44% and 31% of cases, with rate of small-for-size syndrome of 18%. We observed a 12.6 ± 9.8% discrepancy between estimated and intraoperative graft-weight-body-weight ratio, reflecting either volume compliance (overcalculation) or graft enlargement (undercalculation). Graft-to-remnant congestion volume index excluded 1 middle hepatic vein graft. Ninety-four percent single arterial and 100% single ductal biliary reconstructions were associated with 12% hepatic artery thrombosis and 18% biliary anastomotic leaks, respectively.

Conclusions: Our 3-dimensional computed tomography-magnetic resonance cholangiopancreatography computer-assisted surgical planning system enabled (1) virtual navigation of the hilar passage with no need of intraoperative cholangiography in risky anatomy cases and (2) prevention of small-for-size syndrome in extremely small grafts by computed risk analysis.