What is the role of imaging in the detection of recurrence of hepatobiliary disease following whole-liver orthotopic liver transplantation (OLTX)?

Updated: Nov 11, 2019
  • Author: Fazal Hussain, MD, MPH; Chief Editor: John Karani, MBBS, FRCR  more...
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Answer

Answer

US, CT scanning, and MRI are insensitive in detecting recurrent, diffuse hepatocellular diseases. Other than excluding other causes of graft dysfunction, the modalities are not helpful in diagnosing recurrent hepatitis B virus (HBV), HCV, primary biliary cirrhosis, or alcohol-related liver disease. Although imaging occasionally can demonstrate severe allograft damage, in most patients the diagnosis of recurrent hepatocellular disease is made clinically based on serum chemistry, immunologic tests, viral serology, and liver biopsy results.

Routine cross-sectional imaging is of little value in detecting primary sclerosing cholangitis (PSC) recurrence. Because of inadequate resolution of peripheral intrahepatic bile ducts, even magnetic resonance cholangiopancreatography (MRCP) is insensitive. Percutaneous transhepatic cholangiopancreatography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP) is required to delineate the early ductal changes of PSC in a transplanted liver.


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