Complications of Liver Transplantation: Multimodality Imaging Approach

Abstract

Liver transplantation is currently an accepted first-line treatment for patients with end-stage acute or chronic liver disease, but postoperative complications may limit the long-term success of transplantation. The most common and most clinically significant complications are arterial and venous thrombosis and stenosis, biliary disorders, fluid collections, neoplasms, and graft rejection. Early diagnosis is crucial to the successful management of all these complications, and imaging plays an important role in the diagnosis of all but graft rejection. A multimodality approach including ultrasonography and cross-sectional imaging studies often is most effective for diagnosis. Each imaging modality has specific strengths and weaknesses, and the diagnostic usefulness of a modality depends mainly on the patient's characteristics, the clinical purpose of the imaging evaluation, and the expertise of imaging professionals.

Treatment of an elderly patient with hepatocellular carcinoma: Counseling from the patient's point of view

“…Under Schwartz et al's approach, 6 the subset of elderly patients whose Child-Pugh status is A/B and whose HCC is amenable to ablation therapy would undergo liver transplantation with its associated costs and possibility of early mortality, pain, and various liver transplant-associated complications (more than 40% of liver recipients 25,26 ); in addition, that same number of donor livers could not help other patients. In contrast, if this same elderly subgroup of patients were to undergo RFA, the cost would be much lower, the patients would suffer much less pain, the complication rate would be only approximately 2.5%, 15 and the patients would live as long as, or maybe even longer than, they would have if liver transplantation had been performed; moreover, that same number of other patients would get the chance to receive a lifesaving liver transplant.…”

Depicting surgical anatomy of the porta hepatis in living donor liver transplantation

“…While liver transplantation is often the best treatment option for patients with end-stage acute or chronic hepatic disease, vascular complications following transplantation may hamper long-term success (3). These complications have been reported to have an incidence rate as high as 9% (4).…”

Expectations from imaging for pre-transplant evaluation of living donor liver transplantation

“…Anastomotic bleeding, stenosis and pseudoaneurysm formation are some of the other common arterial complications. Significant difference in caliber between donor and recipient arteries, small caliber of the anastomosed vessels, clamp injury and presence of an interpositional conduit are among the usual causes for anastomotic stenosis and HAT [33] .…”

“…Complications that may occur with respect to the portal veins in the recipient are stenosis and thrombosis. Portal vein stenosis tends to develop at the anastomosis while thrombosis is seen with vessel malalignment, differences in caliber of the anastomosed vessels causing turbulent flow or prior thrombosis in the recipient [33] .…”