Role of Magnetic Resonance Imaging in Evaluating Donor Eligibility for Living Donor Liver Transplantation: Present Status and Future Directions

Contrast-enhanced computed tomography (CECT) evaluation of a potential living donor liver transplantation (LDLT) donor is an established component of donor eligibility tests. Usually noncontrast magnetic resonance imaging (MRI) is performed with the aim of assessing biliary anatomy and liver fat fraction. While a few donors are considered ineligible for LDLT after CECT, primarily due to moderate liver steatosis or inadequate liver remnant, other hepatic or extrahepatic abnormalities may also preclude donation. Knowledge regarding vascular anatomy is essential to provide a roadmap to the surgeon but is seldom a reason for donor rejection with the developments in surgical technique and expertise.

Noncontrast MRI can be utilized to comprehensively screen eligible LDLT donors, even before CECT evaluation, as it provides a detailed hepatic and extrahepatic abdominal evaluation along with volumetric estimation without any extra expenditure. This practice not only helps to avoid undue exposure to CT radiation and iodinated contrast in unsuitable donors but also provides guidance for pretransplant modifications in terms of weight reduction in marginal donors with borderline high-fat content by taking advantage of the robust MRI-based liver fat estimation.