Imaging of complications in liver transplantation.

Abstract

Hepatic transplantations are being performed with increasing frequency, leading to greater demand for accurate evaluation of related complications. Ultrasonography (US) is the primary screening technique for detection of vascular complications of hepatic transplantation; angiography is used to confirm the US fmdings or when the US study is suboptima!. Hepatic artery thrombosis, the most common (as high as 42% of pediatric cases;

Preoperative liver donor evaluation: Imaging and pitfalls

“…This course may necessitate alteration of the routine sequence of vascular anastomoses during transplantation such that the arterial anastomosis is performed before the portal venous anastomosis. 36 Depiction of the arterial supply to segment IV, which arises from the right hepatic artery in approximately 11% of patients, is very important because preservation of the vascular supply to segment IV is mandatory to ensure function of this segment in the donor 7,37 (Fig. 5).…”

“…A small-caliber recipient hepatic artery (3 mm or less) or multiple small hepatic arteries supplying the liver from different sources may result in inadequate arterial inflow to the graft after transplantation and may require an alternative inflow source, such as an aortohepatic interposition graft. 36 …”

Ruolo diagnostico dell’US color Doppler nel I anno di follow-up posttrapianto epatico (OLT)

“…Following OLT, each patient received immunosuppressive induction therapy with cyclosporine or tacrolimus (FK 506)+prednisone±azathioprine or mycophenolate mofetil (MMF), followed by maintenance therapy with cyclosporine+prednisone±azathioprine or [1]. A partire da allora si è assistito ad un continuo incremento delle percentuali di sopravvivenza dei pazienti trapiantati, correlabile oltre che all'affinarsi della tecnica chirurgica ed alla disponibilità di più idonei farmaci immunosoppressori anche ad una sempre più efficace sorveglianza clinicostrumentale post operatoria [2]. Scopo del monitoraggio post-OLT è diagnosticare tempestivamente: complicanze vascolari [3] MMF+sirolimus, according to individualised treatment regimens.…”

“…Since then, the survival rates of transplant patients have constantly increased, thanks to improved surgical technique, availability of more suitable immunosuppressive drugs and more effective clinical and imaging postoperative surveillance [2]. The purpose of post-OLT monitoring is to provide an early diagnosis of vascular complications (thrombosis, stenosis and dilatation of the hepatic artery, portal vein and vena cava) [3], biliary complications (fistulas, intrahepatic and anastomotic strictures, abscess formation and lithiasis), sacculated collections (haemorrhagic, biliary, ascitic, purulent), and de novo malignancies induced by immunosuppression.…”

“…(LF). Sensibilità, specificità, valore predittivo positivo, valore predittivo negativo ed accuratezza diagnostica dell'indagine sono stati rispettivamente: 79,2%, 97,3%, 86,3%, 95,5%, 94% (B), 100%, 100%, 100%, 100%, 100% (V) e 100%, 96,9%, 42,8%, 100%, 97% (LF) …”