Hepatobiliary Scintigraphy in the Preoperative Evaluation of Potential Living Liver Donors

Graft selection strategy in living donor liver transplantation (LDLT) is usually multifactorial, but special attention is paid to the determination of donor liver volumes to minimize any risk of posthepatectomy liver failure (PHLF). Hepatobiliary scintigraphy (HBS) with single-photon-emission computed tomography allows for the measurement of total and future liver remnant function (FLR-F) and has been shown to predict the risk of PHLF more accurately than liver volumetry. Since November 2016, HBS has been performed at our Institution in every candidate to major hepatectomy, including potential living liver donors. Thirty-seven consecutive patients were submitted to HBS, of whom 7 were potential living liver donors. After completed hepatectomy (n = 27), the median FLR-F of patients who developed PHLF (n = 9) was 1.72%/min/m2 (range 1.40–2.78) compared to that of patients who did not (n = 18), which was 4.02%/min/m2 (range 1.15–12.08). Three donors underwent operations (1 right hepatectomy and 2 left hepatectomies). In the only donor who developed PHLF, the FLR accounted for the 37% of the total liver volume, whereas the FLR represented only the 31% of the total liver function (TL-F = 11.29%/min) with a resulting FLR-F of 2.05%/min/m2. The present study suggests that a non-invasive low-cost exam such as HBS may be a promising tool to predict PHLF not only in neoplastic patients but also to evaluate potential living donors. Larger studies are needed to draw any conclusion regarding the benefits of HBS in the living liver donor workup. •Donor safety must be mandatory in living donor liver transplantation (LDLT) and every effort must be made to minimize the risk of donor complications.•Hepatobiliary scintigraphy (HBS) with single-photon-emission computed tomography allows for the measurement of the regional distribution of liver function and may predict the risk of post-hepatectomy liver failure (PHLF).•A non-invasive low-cost exam such as HBS may also be helpful in preventing PHLF in an LDLT setting and may be included in the standard preoperative workup of donors.