Introduction : Biliary complications still remain the major causes of morbidity and mortality after living donor liver transplantation. It has been done for identifying the point of biliary leakage by an endoscopic retrograde cholangiopancreatography (ERCP). However, this can lead to retrograde cholangitis, pancreatitis and is not sufficient to diagnose bile leakage from cuts surface. The aim of the study is to describe of usefulness of Magnetic resonance image (MRI) with 40min delay phage examination (MRI pancreatobiliary fistula protocol).

Methods : From March 2012 to December 2018. 869 adult LDLT were performed in Seoul National University Hospital. There was 44 cases of recipients underwent MRI pancreatobiliary protocol. We reviewed 44 cases of these cases with their clinical outcomes.

Results : In radiologic examinations performed in patients suspected of bile leakage, 68% of the patients had bile leakage. Cut surface leakage was diagnosed in 2 cases, and the other cases were diagnosed biliary leakage from anastomosis site. Most patient (25/30) with leakage underwent percutaneous drainage and ERCP. It was used for checking bile secretion function of hepatocyte. There was no contrast enhanced bile duct image in 3 cases. 1 case is with severe rejection. It might be related with hepatocyte secretary dysfunction.

Conclusions : MRI pancreatobiliary fistula protocol is feasible and safe non-invasive procedure for identifying biliary leakage site.