Preoperative radiological assessment of living donor liver transplantation: The impact of median arcuate ligament compression on post-transplant complications in recipients

Objective: The study aims to investigate the effect of postoperative complications in recipients of live donors with median arcuate ligament compression syndrome and contribute to the accurate selection of donors. Materials and Methods: Between January 1, 2020, and June 30, 2022, dynamic abdominal computed tomographies of 2745 donor candidates were retrospectively reviewed. Abdominal computed tomographies of all patients within the specified date range were evaluated in all planes (axial, sagittal, and coronal) to confirm the presence of median arcuate ligament compression. The complication rates in recipients of both donor candidates with MAL compression and those without MAL compression who underwent surgery were determined and compared. Results: Among the 2745 donor candidates included in our study, median arcuate ligament (MAL) compression was found in 156 (5.7%), while no MAL compression findings were observed in 2589 (94.3%). Out of 2745 donor candidates, 575 donors underwent surgery. Among these donors, 7% (39) were diagnosed with MALS (patient group), while 93% (536) were not (control group). Among the 575 operated donors with MALS diagnosis, 28% (11) were female and 72% (28) were male, whereas among the donors without MALS diagnosis, 38% (204) were female and 62% (332) were male. Complication rates in recipients after surgery were examined in the study, and although there was no significant overall difference between the patient and control groups, when complications were considered separately, it was revealed that recipients of donors with MAL compression had a higher incidence of biliary complications compared to those without MAL compression. Conclusion: This study evaluates the impact of Median Arcuate Ligament compression on post-transplant complications in recipients of donors. Our findings suggest that donors with MAL compression may have an increased risk of biliary complications in ix recipients, emphasizing the need to be cautious when selecting donors with this syndrome. Keywords: MALS, donor, LDLT, complication.