Multimodality Imaging of Normal Hepatic Transplant Vasculature and Graft Vascular Complications

Roberts, Jeffrey H.; Mazzariol, Fernanda S.; Frank, Susan J.; Oh, Sarah K.; Koenigsberg, Mordecai; Stein, Marjorie W.

doi:10.4103/2156-7514.86665

Cited by 12 publications

(14 citation statements)

References 20 publications

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“…Bei einer End-zu-End-Anastomose fand sich in einer Studie ein Niedrigwiderstandsprofil, während sich bei infrarenalem, aortohepatischem Bypass ein Hochwiderstandsprofil mit niedrigem diastolischen Fluss fand [10]. Transient lässt sich zudem in den ersten Tagen nach erfolgter Lebertransplantation bei etwa der Hälfte der Patienten ein erhöhter RI über der A. hepatica ableiten [6,8,11,12]. Zudem wurden in einer Verlaufsstudie über 4 Jahre nach Lebertransplantation auch bei Patienten ohne Nachweis einer Pathologie der A. hepatica mind.…”

Section: Normal-und Grenzbefunde Nach Lebertransplantationunclassified

“…Obwohl eine Tardus-parvus-Wellenform über der A. hepatica als pathognomonisch für eine HAS gilt, sind falsch-positive Befunde möglich, z. B. auf dem Boden einer Diskrepanz zwischen Empfänger-und Spenderarterie, oder bei einer HAT mit Kollateralgefäßen [12,36,37]. Zudem kann eine systolische Akzelerationszeit > 0,08 sec in Kombination mit einem prominent hohen RI > 0,7 auch auf eine Rejektion hinweisen [38].…”

Section: A Hepatica-stenose (Has)unclassified

“…Letzteres kann aber in den ersten Tagen nach Lebertransplantation auch ohne Nachweis einer Pathologie der A. hepatica transient vorkommen [6]. Suspekt auf Vorliegen eines arteriellen Steal-Syndroms ist die Persistenz eines hohen arteriellen Widerstandprofils über der A. hepatica mehr als 72 Stunden nach Lebertransplantation [8,12]. In einer Studie an 244 Patienten wiesen solche mit splenischem Steal-Syndrom (n = 8) einen größeren Milzarteriendurchmesser (9,2 ± 1,7 mm vs. 7,2 ± 0,8 mm; p < 0,05) und über der Milzarterie eine höhere Spitzenflussgeschwindigkeit (877 ± 76 ml/Minute vs. 760 ± 77 ml/Minute; p < 0,05) auf [46].…”

Section: Arterielle Steal-syndromeunclassified

“…Die Ableitung arterieller Doppler-Signale über dem Areal einer Pfortaderthrombose kann auf eine maligne Thrombose (z. B. im Sinne einer Tumorinfiltration in die Pfortader) hinweisen [12]. Sonografische Zeichen einer Pfortaderstenose, häufig im Bereich der Anastomose, sind eine Lumeneinengung, ein Aliasing-Phänomen im Doppler-Modus sowie eine poststenotische Dilatation.…”

Section: Pfortaderthrombose Und Pfortaderstenoseunclassified

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Sonografie nach Lebertransplantation

Welker

Friedrich‐Rust

2015

Z Gastroenterol

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Section: Normal-und Grenzbefunde Nach Lebertransplantationunclassified

Section: A Hepatica-stenose (Has)unclassified

Section: Arterielle Steal-syndromeunclassified

Section: Pfortaderthrombose Und Pfortaderstenoseunclassified

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Sonografie nach Lebertransplantation

Welker

Friedrich‐Rust

2015

Z Gastroenterol

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“…For the conventional OLT approach, since the recipient’s retrohepatic IVC is resected together with the native liver during the hepatectomy [16], [19], extending a stent-graft from the TIPS tract into IVC of the bridged recipient should not interfere with subsequent OLT surgery. In contrast, for the piggyback OLT approach, the donor liver is transplanted with a short segment of the donor IVC, which is then directly anastomosed to the main hepatic vein confluence of the recipient [20]–[22]. Since the piggyback technique is the most widely used liver transplant surgery around the world to date [19], it is ideal for OLT that the main hepatic veins of the bridged recipients are preserved with no extension of the TIPS stent-grafts into IVC.…”

Section: Introductionmentioning

confidence: 99%

MRI-Monitored Intra-Shunt Local Agent Delivery of Motexafin Gadolinium: Towards Improving Long-Term Patency of TIPS

et al. 2013

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BackgroundTransjugular intrahepatic portosystemic shunt (TIPS) has become an important and effective interventional procedure in treatment of the complications related to portal hypertension. Although the primary patency of TIPS has been greatly improved due to the clinical application of cover stent-grafts, the long-term patency is still suboptimal. This study was to investigate the feasibility of using magnetic resonance imaging (MRI)-monitored intra-shunt local agent delivery of motexafin gadolinium (MGd) into shunt-vein walls of TIPS. This new technique aimed to ultimately inhibit shuntstenosis of TIPS.MethodologyHuman umbilical vein smooth muscle cells (SMCs) were incubated with various concentrations of MGd, and then examed by confocal microscopy and T1-map MRI. In addition, the proliferation of MGd-treated cells was evaluated. For in vivo validation, seventeen pigs underwent TIPS. Before placement of the stent, an MGd/trypan-blue mixture was locally delivered, via a microporous balloon, into eleven shunt-hepatic vein walls under dynamic MRI monitoring, while trypan-blue only was locally delivered into six shunt-hepatic vein walls as serve as controls. T1-weighted MRI of the shunt-vein walls was achieved before- and at different time points after agent injections. Contrast-to-noise ratio (CNR) of the shunt-vein wall at each time-point was measured. Shunts were harvested for subsequent histology confirmation.Principal FindingsIn vitro studies confirmed the capability of SMCs in uptaking MGds in a concentration-dependent fashion, and demonstrated the suppression of cell proliferation by MGds as well. Dynamic MRI displayed MGd/blue penetration into the shunt-vein walls, showing significantly higher CNR of shunt-vein walls on post-delivery images than on pre-delivery images (49.5±9.4 vs 11.2±1.6, P<0.01), which was confirmed by histology.ConclusionResults of this study indicate that MRI-monitored intra-shunt local MGd delivery is feasible and MGd functions as a potential therapeutic agent to inhibit the proliferation of SMCs, which may open alternative avenues to improve the long-term patency of TIPS.

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Current Endovascular Management of Arterial Complications After Pediatric Liver Transplantation in a Tertiary Center

Marra,

Muglia,

Capodaglio

et al. 2023

Cardiovasc Intervent Radiol

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Purpose Pediatric liver transplant surgery is burdened by arterial complications whose endovascular treatment is not standardized. We report the outcomes of a cohort of pediatric recipients with hepatic artery complications treated by endoluminal procedures. Materials and Methods From December 2019 to December 2022, consecutive transplanted pediatric patients who underwent endovascular treatment of hepatic artery complications were reviewed. The analysis included: type of complication (occlusion, stenosis, pseudoaneurysm); onset (acute = < 15 days, subacute = 15–90 days, late = > 90 days); endovascular technique (angioplasty, stenting); complications and outcomes. Technical success was defined as the opacification of the hepatic artery at the final angiogram with < 50% residual stenosis and no pseudoaneurysms. Clinical success was defined by graft’s and patient’s survival. Results Seventeen patients (8 males; median age 33 months, IQR 9–103) underwent 21 hepatic arteriography procedures for predominantly acute or subacute occlusions (n = 7) or stenosis (n = 11) with concurrent pseudoaneurysms (n = 4). Primary and secondary technical success was achieved in 13/18 and 3/3 procedures, respectively, with overall technical success of 76%. Angioplasty alone was successful in 5/21 procedures; stent-retriever thrombectomy was performed in one occlusion with thrombosis; stenting was required in 9/17 (53%) patients. Clinical success was obtained in 14/17 (82%) patients with hepatic artery patency after a median of 367 days (IQR 114.5–500). Clinical failure occurred in 3 permanent occlusions, with 2 deaths and 1 re-transplantation. Procedure-related complications included minor events in 3/17 (18%) patients and 1/17 (6%) death. Conclusion In liver transplanted children with hepatic artery complications, endovascular treatment may provide clinical success, with stenting often required in acute and subacute conditions. Level of Evidence Level 4. Graphical Abstract

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Multimodality Imaging of Normal Hepatic Transplant Vasculature and Graft Vascular Complications

Cited by 12 publications

References 20 publications

Sonografie nach Lebertransplantation

Sonografie nach Lebertransplantation

MRI-Monitored Intra-Shunt Local Agent Delivery of Motexafin Gadolinium: Towards Improving Long-Term Patency of TIPS

Current Endovascular Management of Arterial Complications After Pediatric Liver Transplantation in a Tertiary Center

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