Post-operative imaging in liver transplantation: State-of-the-art and future perspectives

Abstract

Orthotopic liver transplantation (OLT) represents a major treatment for end-stage chronic liver disease, as well as selected cases of hepatocellular carcinoma and acute liver failure. The ever-increasing development of imaging modalities significantly contributed, over the last decades, to the management of recipients both in the pre-operative and post-operative period, thus impacting on graft and patients survival. When properly used, imaging modalities such as ultrasound, multidetector computed tomography, magnetic resonance imaging (MRI) and procedures of direct cholangiography are capable to provide rapid and reliable recognition and treatment of vascular and biliary complications occurring after OLT. Less defined is the role for imaging in assessing primary graft dysfunction (including rejection) or chronic allograft disease after OLT, e.g., hepatitis C virus (HCV) recurrence. This paper: (1) describes specific characteristic of the above imaging modalities and the rationale for their use in clinical practice; (2) illustrates main imaging findings related to post-OLT complications in adult patients; and (3) reviews future perspectives emerging in the surveillance of recipients with HCV recurrence, with special emphasis on MRI.

Pediatric Liver Transplant: Techniques and Complications

“…It can also be performed at the bedside, providing quick answers to referring physicians, which is central to the management of these patients (20). However, US is highly operator dependent and can be challenging in patients with limited acoustic windows (21). It is therefore crucial that radiologists and sonographers are accurately trained to apply the capabilities of US to assist in diagnosis.…”

Portal Venous Interventions after Liver Transplant

“…11,12 Other less frequently encountered factors known to increase risk of PVS include retransplantation surgeries, prior splenectomy, or prior portal vein thrombosis. 5,13 PVS usually occurs late (>6 months), likely secondary to scarring and neointimal hyperplasia. 5,[13][14][15] When occurring early (<6 months), technical reasons are suspected.…”

“…5,13 PVS usually occurs late (>6 months), likely secondary to scarring and neointimal hyperplasia. 5,[13][14][15] When occurring early (<6 months), technical reasons are suspected. 5 Presentation is highly variable, ranging from overt graft dysfunction, with elevated liver enzymes and sequelae of portal hypertension (variceal bleeding, ascites, splenomegaly), to entirely asymptomatic.…”

Abdominal cross-sectional imaging of the associating liver partition and portal vein ligation for staged hepatectomy procedure

“…Similarly to other liver applications[41-44], MRI should be performed with 1.5 Tesla or 3.0 Tesla magnets, equipped with highly performing gradients and multi-element surface coils (preferably 8-16 elements) implementing parallel imaging. Our MRI protocol is illustrated in Table 2.…”