Imaging Spectrum of Donor Biliary Complications After Living Liver Donation: An MRCP-Based Analysis

INTRODUCTION: To evaluate the imaging spectrum of biliary complications in living liver donors using magnetic resonance cholangiopancreatography (MRCP) and to investigate the relationship between postoperative biliary complications and biliary anatomy.
METHODS: In this retrospective single-center study, adult living liver donors who underwent transplantation between January 2017 and January 2025 were reviewed. Donors were followed clinically and with imaging according to institutional protocols, and MRCP was performed when biliary complications were suspected. Preoperative MRCP examinations were analyzed to classify biliary anatomy and obtain morphometric measurements. Imaging characteristics were compared between donors with and without biliary complications.
RESULTS: A total of 181 donors were included, and radiologic biliary complications were identified in 16 donors (8.8%). Early bile leakage and biloma formation constituted the predominant imaging phenotype (68.8%), whereas biliary strictures were less frequent, presenting as common hepatic duct narrowing within the first month in three donors and as later strictures detected at 5.5 and 8 months in two donors. Variant biliary anatomy appeared numerically more frequent among donors with complications but was not significantly associated with complication development (p=0.282). Hepatocyte-specific contrast–enhanced MRI confirmed active bile leakage in selected cases. Three donors demonstrated biochemical cholestasis despite normal MRCP findings, highlighting the role of imaging in avoiding unnecessary invasive procedures.
DISCUSSION AND CONCLUSION: MRCP provides a comprehensive, noninvasive framework for detecting biliary complications in living liver donors. Early imaging should focus on bile leak, while later surveillance is important for identifying biliary strictures, supporting a time-oriented radiologic approach to donor follow-up.

Keywords: Living donor liver transplantation, Magnetic resonance cholangiopancreatography (MRCP), Biliary complications, Bile leak, Biloma, Biliary stricture