Preoperative Evaluation of Potential Living Donors for Liver Transplantation: The Role of Helical Computed Tomography-Angiography J.K.F. Chan, W.K. Tso, C.M. Lo, S.T. Fan, K.L. Chan, P. Tam, W. Wei, H. Saing, M.T. Chau, L. Leong, and F.L. Chan S URVIVAL of the transplanted liver depends on the patency of its supplying vessels. Accurate knowledge of the hepatic vascular anatomy of donors for living-related transplantation (LRT) would reduce the incidence of vas- cular complications after transplantation. Routine preoper- ative evaluation of our LRT donors requires both computed tomography (CT) and conventional angiography. 1 We look at the feasibility of using hepatic CT angiography (CTA) to replace conventional angiography. MATERIALS AND METHODS Nonenhanced and enhanced helical CT (3 mm collimation refor- matted to 1.5 mm, 140 to 170 mL contrast medium, injection rate 3 to 5 mL/s, pitch 1 to 1.7). Hepatic artery anatomy was determined from both axial and reconstructed maximum intensity projection (MIP) images. Portal venous images were used for liver volume calculation and assessment of liver morphology. CTA findings were correlated with either conventional angiogram or surgery or both. RESULTS Between September 1995 and December 1996, 19 adults with relatives suffering from end-stage liver failure were recruited for consideration as living liver donors. CTA was performed in 16 patients. Images useful in determining hepatic arterial anatomy were obtained in 15 patients. Conventional hepatic arterial anatomy is found in 12 patients (Fig 1); replaced right hepatic artery from superior mesenteric artery in 1 patient; replaced left hepatic artery from left gastric artery in 2 patients. Other variations noted on CTA in these 15 patients included early bifurcation of the right hepatic artery (n = 1) and dual supply to the left lateral segment (n = 1). There was no substantial discrepancy with CTA findings in the 10 donors who had a conventional angiogram performed. CTA findings were later confirmed in 13 patients who had donor hepatectomy performed. DISCUSSION Arterial thrombosis has been a dreaded complication after living related liver transplantation. It constitutes the most common serious complication after liver transplant and is associated with a high mortality rate of approximately 50%. 1 Arterial thrombosis is preventable if grafts with unfavorable arterial anatomy are excluded. 2 Transplant surgeons tend to use the donor with the ideal hepatic arterial anatomy, that is, a single left hepatic artery of at least 3 mm. 3 In the preoperative evaluation of liver donors, both conventional angiogram and CT scan of the liver are done: angiogram to define the hepatic artery anatomy, CT scan for liver volume calculation and morphologic assessment. Whilst conventional angiogram is a mostly safe procedure, it is invasive and poses potential hazards to the donor. The From the Departments of Diagnostic Radiology (J.F.K.C., W.K.T., M.T.C., L.L., F.L.C.), and Surgery (C.M.L., S.T.F., K.L.C., P.T., W.W., H.S.), Queen Mary Hospital, Hong Kong, People’s Republic of China. Address reprint requests to Dr John K.F. Chan, Department of Diagnostic Radiology, Queen Mary Hospital, Pokfulam, Hong Kong, People’s Republic of China. Fig 1. Hepatic CTA of a donor with left and right hepatic arteries arising from the common hepatic artery. © 1998 by Elsevier Science Inc. 0041-1345/98/$19.00 655 Avenue of the Americas, New York, NY 10010 PII S0041-1345(98)00991-9 Transplantation Proceedings, 30, 3197–3198 (1998) 3197