الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Living donor liver transplantation (LDLT) has become a valuable treatment for patients with end-stage liver disease who cannot receive deceased donor livers. Imaging of both the pre- and post transplant patient is an important step of patient assessment MDCT has emerged as single most non-invasive imaging modality and permit comprehensive and accurate preoperative evaluation of clinically relevant information required to select suitable candidate and surgical technique for successful transplantation. It helps to evaluate liver parenchyma, hepatic vascular anatomy and predict adequacy of liver volume in prospective donor more efficiently. Recipients are better evaluated by MDCT for exclusion of advanced HCC and other malignancies, patency of venous system, presence of perihepatic varices and portosystemic shunts, patency of celiac artery and exclusion of splenic artery aneurysm. The purpose of our study was to evaluate the significance of multidetector CT in the pre operative evaluation of both potential donors and recipients for LRLT and the possible post operative complications. This study included 26 transplant patients and their corresponding donors, The recipients were 23 males and 3 females, age range 30 - 60 year, mean age 47.9. The donors were 22 males and 4 females, age range 19 - 40 years, mean age 27.96 .All subjects are evaluated by triphasic CT of the abdomen using 16-row multidetector scanner. CT angiography with 3D reconstruction techniques as well as CT Volumetry were additionally done for donors in preoperative assessment.
CT was performed at least once after transplantation for all recipients and for nineteen of the donors in order to evaluate vascular structures and determine possible complications.
1- Pre- operative assessment:
i- Recipients: Recipients were evaluated for exclusion of advanced HCC and other malignancies, patency of venous system, presence of perihepatic varices and portosystemic shunts. We found that liver cirrhosis was the commonest indication for liver transplantation and all our included HCC patients were stage II.
ii- Donors: Donors were evaluated to exclude focal liver lesions, and determine hepatic volume, Postcontrast CT angiography was obtained for the arterial and venous phases for hepatic vascular mapping. All data were analyzed to detect vascular variants, and preoperative findings were correlated with intraoperative finding. All donors underwent right lobe hepatectomy. Preoperative calculations of graft volume according to CT volumetry did not yield statistically significant difference when compared to the intraoperative findings. Standard hepatic anatomy was seen at (69.2%), while (30.8%) showed hepatic arterial variations. Classic portal vein anatomy was determined in (92.3%), while variations in (7.7%). Standard hepatic venous anatomy was found in (57.7%), while (42.3%) presented hepatic venous drainage variants. Compared to surgical findings, MDCT correctly identified hepatic arterial and portal venous anatomy in all cases with no false positive or false negative cases. Sensitivity, specificity, PPV, NPV and accuracy of MDCT in identification of hepatic arterial and portal anatomy were all 100%, while for hepatic venous anatomy, the corresponding values were 85.71 %, 84.21 %, 66.67 %, 94.12 %and 84.6 %,respectively.
2- post operative assessment:
i- Recipients: Regarding recipient complications, a total of 11 biliary complications occured in 8 patients (30.7%). Consists of biliary strictures, leak and bilomas, and cholangitic abscess formation. 11 different vascular complications occurred in 7/26 cases (26.9%) varied from portal vein stenosis/ thrombosis, hepatic artery stenosis, and venous graft thrombosis. Different forms of abnormal fluid collections and parenchymal complications are detected by CT.
ii- Donors: CT detected 11 complications in 8 donors (30.7% ) distributed between biliary complications and different forms of abnormal fluid collections. No detected vascular complications.
MDCT is an essential part of pre and post -operative evaluation of potential liver Donors and transplant candidates as it allows for appropriate patient selection for transplantation, assessment of the potential donors with accurate CT-determined graft volumes. MDCT angiography should be used for hepatic vascular mapping and vascular complications as it is a non-invasive comprehensive evaluation tool. CT usually is the next step after US when parenchymal or vascular abnormalities are detected. Biliary complications are better evaluated with T-tube cholangiography, MRI and MRCP.