Introduction : Evaluations of donors’ biliary anatomy in LDLT are obtained from MRCP and IOC. Bile leakage as one of the important complications can be minimised by detail acknowledgment of biliary anatomy by combining MRCP and IOC. This study aims to review donors’ biliary anatomy and the impact of the acknowledgment to technique and duration.

Methods : This single centre retrospective study included 46 adult-to-pediatric and 7 adult-to-adult LDLTs performed in Cipto Mangunkusumo Hospital from 2010-2019. All patients were performed MRCP then synchronised with IOC. All results were classified by Huang Classification. Demographic data, surgical technique, duration, and radiologic discrepancy were collected.

Results : There are 34 cholangiographies out of 53 LDLTs. No biliary complications detected. Forty-nine donors underwent left-lateral sectionectomy and 4 right hepatectomy. Operative duration ranged from 270-600 minutes. The frequency of each type on MRCP/IOC are as follows: Huang A1 40,5%/35,1%; Huang A2 37,8%;37,8%; Huang A3 13,5%/18,9%; Huang A4 5,4%/8,1%; and Huang A5 2,7%/0. Huang A1 has the shortest operative duration and the least blood loss (70cc). Huang A3 has the longest operative duration with the most blood loss (900cc). Discrepancy were found in 6 patients of which 2 underwent longest operative duration and lost the most blood.

Conclusions : Synchronised MRCP and IOC decrease operative duration therefore associated with better outcome. Low discrepancy showed that surgeon does not require nephrotoxic contrast media used in IOC hence reducing surgical duration except for rare cases like Huang A4 and A5 to avoid ligation of major intrahepatic duct.