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Causes of patient death in nine patients were recurrent HCC in four patients, biliary sepsis in two patients, graft failure (not associated with AMR) in one patient, post-operative bleeding after re-LT in one patient, and pneumonia in one patient. Among the other fifteen patients who are alive, five patients got re-LT, three patients presented mild graft dysfunction with well-functioning PTBD, three patients showed resolution of DIHBS and removed biliary drainage, and four patients demonstrate normal graft function with well-maintained biliary drainage. In patients who demonstrated DIHBS, over half of the patient progress to graft failure and need re-LT. [Extracted from the article]

Objectives: To determine the incremental value of hepatobiliary-phase-MRC (HBP-MRC) added to T2-magnetic resonance cholangiography (T2-MRC) for evaluating biliary anatomy in living donor liver transplantation (LDLT) and to correlate T2+HBP-MRC findings with surgical results.Methods: A total of 276 donors who underwent T2 and gadoxetic acid-enhanced MRI before right hemihepatectomy for LDLT between January and December 2016 were retrospectively enrolled. Two reviewers evaluated biliary anatomy classification using T2-MRC in the first session and T2+HBP-MRC in the second session. The sensitivity, specificity, and confidence level (5-point scale) of T2-MRC and T2+HBP-MRC for variant biliary anatomy were evaluated. The agreement rates between MRC and operative cholangiography for each biliary anatomy classification and the underestimation rates for multiple bile duct openings (BDOs) for both MRC techniques were evaluated.Results: Of the 276 donors, variant biliary anatomy was observed in 36.2% (100/276). T2+HBP-MRC showed a significantly higher sensitivity for diagnosing variant biliary anatomy than T2-MRC alone (99.0% [99/100] vs. 89.0% [89/100], p = 0.006), with better observer confidence level (4.9 ± 0.3 vs. 4.6 ± 0.7, p < 0.001) and inter-observer agreement (kappa, 0.902 vs. 0.730). Compared with T2-MRC alone, T2+HBP-MRC provided significantly higher agreement with operative cholangiography in biliary anatomy classification (98.6% [272/276] vs. 89.9% [248/276], p < 0.001), and significantly lower underestimation rate for multiple BDOs (5.8% [16/276] vs. 9.4% [26/276], p = 0.002).Conclusion: T2+HBP-MRC might be considered than T2-MRC alone, as a better depiction of biliary anatomic variations, correlated with surgical findings.Key Points: •T2+HBP-MRC predicted variant biliary anatomy more accurately than T2-MRC alone. •T2+HBP-MRC might have clinical usefulness by reducing the underestimation rate of multiple bile duct openings, which requires more complicated biliary anastomoses. [ABSTRACT FROM AUTHOR]

We aimed to determine the visibility of bile ducts of the caudate lobe (B1s) and right/left (R/L) dissociation on contrast-enhanced T1-magentic resonance cholangiography after gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid administration (CE-T1-MRC) in live liver donors. In 300 live liver donors who underwent CE-T1-MRC, the visibility and R/L dissociation of B1 were evaluated. Confidence level of B1 visibility and depiction of the presence of R/L dissociation on axial and coronal reconstruction images were compared. Strength of agreement between R/L dissociation on MRC and that on intraoperative cholangiography was evaluated. At least 1 B1 was visible on CE-T1-MRC in 142 of 300 subjects (47.3%; a total of 195 B1s; 0.64 [SD, 0.80], 0-4 branches per person). Of 195 subjects with visible B1, 55 ducts showed R/L dissociation (28.2%; right-to-left crossover, n = 28; left-to-right crossover, n = 27). The confidence level of B1 visibility on axial images of MRC was significantly higher than that on coronal images of MRC (P <.001). Of 55 B1s with R/L dissociation, axial images were superior to coronal images in depicting B1 crossover in 31 and vice versa in 2 (equal between axial and coronal images in 22). The agreement for R/L dissociation between CE-T1-MRC and intraoperative cholangiography was excellent (κ = 0.819; 95% CI, 0.722-0.917). Bile ducts of the caudate lobe with R/L dissociation can be occasionally identified on CE-T1-MRC. Axial reconstruction is superior to coronal counterpart. [ABSTRACT FROM AUTHOR]