What is the role of imaging in detecting post-liver transplantation complications?

Updated: Nov 11, 2019
  • Author: Fazal Hussain, MD, MPH; Chief Editor: John Karani, MBBS, FRCR  more...
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Similarly, imaging plays an important role in detecting postsurgical complications. US is excellent for screening for biliary, arterial, and venous problems. [4] Doppler ultrasonography plays an important role in the postoperative management of liver transplantation. [5, 6, 7] Contrast-enhanced, dual-phase CT scanning and nonenhanced CT scanning can help to detect or confirm these postoperative complications. CT scanning is especially useful in depicting fluid collections and is most commonly used to guide percutaneous aspirations and abscess drainages. [8, 9, 10, 11, 12, 13, 14] With the availability of advanced scanners, magnetic resonance imaging (MRI), MR angiography (MRA), MR venography (MRV), and MR cholangiopancreatography (MRCP) are increasingly used to better define the postoperative biliary tree and to evaluate hepatic vascular anatomy and patency. Many complications can be temporized or corrected by using interventional radiologic techniques. Some can be treated by using endoscopic retrograde cholangiopancreatography (ERCP). With a combination of these tools, many patients can be spared the morbidity and potential mortality associated with repeat operation or retransplantation. [15, 16, 17, 9]

(See the images below of transplantation complications.)

Spectral Doppler ultrasonographic waveform of the Spectral Doppler ultrasonographic waveform of the right hepatic artery in a 60-year-old man, 8 years after orthotopic liver transplantation. The image demonstrates the typical rounded tardus parvus waveform morphology, which is indicative of upstream arterial thrombosis or severe stenosis. Subsequent angiography confirmed occlusion at the hepatic arterial anastomosis.
A-1: Magnetic resonance angiogram in a transplanta A-1: Magnetic resonance angiogram in a transplantation patient with hepatic artery thrombosis. Magnetic resonance angiogram of the recipient celiac axis depicts complete occlusion of the hepatic artery.
A-5: Digital subtraction angiogram obtained during A-5: Digital subtraction angiogram obtained during balloon angioplasty of a stenotic artery.
Transjugular portography demonstrates extensive po Transjugular portography demonstrates extensive portal vein thrombus in the whole-liver allograft of a 40-year-old woman whose clinical condition rapidly deteriorated on postoperative day 39.

Lee et al retrospectively enrolled 75 patients who had undergone liver transpalantation and found that although MDCT in the late period should be interpreted with caution in patients with suspected biliary complication, MDCT is a reliable diagnostic technique for the identification of early and late abdominal complications after liver transplantation. [18]  In a separate study, Boraschi et al found MDCT to be a reliable diagnostic technique for early abdominal complications of liver recipients. [19]

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