Background: Current evaluation of donor candidates for adult-to-adult living donor liver transplant (LDLT) includes MRI and CT without and with contrast for defining liver anatomy. Donor and recipient size matching is a critical determinant for donation. The most common reasons for rejecting potential donors are a small left lobe either inadequate in size for donation (GBWR < 0.8) or which would leave a remnant of <30% liver volume for right lobe donation. Our hypothesis was that a single sequence non-contrast-enhanced MRI (SSMRI) performed in less than a minute can be used to rapidly determine liver volumes and identify candidates who should not be evaluated further for LDLT. If successful, use of SSMRI early in donor evaluations will improve safety and efficiency by avoiding unnecessary patient exposure to ionizing radiation and iodinated contrast media and evaluation of futile donor candidates. Methods: Of 31 consecutive adults undergoing evaluation for LDLT, 30 had routine pre- and post-contrast hepatic CT and MRI, including HASTE sequence used for SSMRI volume determination. Liver volumes were determined by a radiologist using commercially available software. Data were analyzed for statistical difference between SSMRI and CT volumes for total, right and left lobes. Percent volume difference (SSMRI – CT/CT) was calculated. Results: There was 100% agreement (no statistically significant difference) between volume determinations by SSMRI and CT imaging. The average percent difference between CT and SSMRI for total liver volume was 0.9 + 5.7%, for the right lobe 2.2 + 7.1% and for the left lobe -1.5+9.9%. Of the 31 evaluated, 3 had a left lobe volume of < 30% by SSMRI (14.7, 20.6, and 21.2%). Conclusions: SS MRI accurately estimates liver volume. Adoption of donor screening whereby those with a small left lobe volume on SSMRI are excluded from further evaluation improves the efficiency, cost and safety of LDLT evaluation. More LDLT candidate evaluations will be encouraged by the possible avoidance of unnecessary radiation and contrast exposure, and improvement in the efficiency of evaluation will enable centers to perform more living donor candidate evaluations.

CITATION INFORMATION: Schilsky M, Cartiera K, Boga S, Schilsky S, Emre S, Mulligan D, Weinreb J, Israel G. Improving the Efficiency, Safety and Cost of Evaluating Living Donor Liver Candidates Using Single Sequence MRI. Am J Transplant. 2016;16 (suppl 3).

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