US of Liver Transplants: Normal and Abnormal

Abstract

Whole-liver transplantation is an accepted and successful method of treating end-stage liver disease. As a result of the shortage of cadaveric livers, split-liver transplantation and living donor liver transplantation are becoming more commonplace. Ultrasonography (US) is the initial imaging modality of choice for detection and follow-up of early and delayed complications from all types of liver transplantation. Vascular complications include thrombosis and stenosis of the hepatic artery, portal vein, or inferior vena cava, as well as hepatic artery pseudoaneurysms and celiac artery stenosis. Biliary complications include leaks, strictures, stones or sludge, dysfunction of the sphincter of Oddi, and recurrent disease. Neoplastic disease in the transplanted liver may represent recurrent neoplasia or posttransplantation lymphoproliferative disorder. Parenchymal disease may take the form of a focal mass or a diffuse parenchymal abnormality. Perihepatic fluid collections and ascites are common after liver transplantation. Knowledge of the surgical technique of liver transplantation and awareness of the normal US appearance of the transplanted liver permit early detection of complications and prevent misdiagnosis.

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“…Multiple studies have shown that metabolic syndrome increases after transplant, especially in adult patients. 1,4 Reasons for increased rates of metabolic syndrome in transplant patients include being overweight and the adverse effects of immunosuppressive drugs. Multiple studies have shown the effects of metabolic syndrome on adulthood diseases, with increased cardiovascular complications (increased by 10 times) and type 2 DM (increased by 4 times).…”

“…1 A return to ordinary lifestyle activities with normalized hypermetabolic state (versus that seen with liver insufficiency) and normal diet can cause progressive weight gain in these patients. [2][3][4] Determination of the predisposing factors contributing to mortality in patients with progressive liver insufficiency remains a challenging issue. In addition, determining the optimal time for transplant and the effective factors on short-term and long-term survival are debatable topics in this field.…”

“…These components of metabolic syndrome can increase the risk of cardiovascular disease. [1][2][3][4] As shown in a cross-sectional survey on adult liver transplant, 53% of patients had hypertension, 51% had hyperlipidemia, 37% had hyperglycemia, and 32% of patients had increased waist circumference at least 6 months after operation, with metabolic syndrome observed in 44.5%. 1 Some predisposing factors of metabolic syndrome after liver transplant are immunosuppressive drugs, higher age at time of operation, being male, higher body mass index (BMI) before transplant, pretransplant DM, underlying liver disease, and higher BMI in donors.…”

Minimal Invasive (Endovascular and Percutaneous) Treatment of Post Liver Transplantation Complications in Pediatrics

“…The reported sensitivity of Doppler US for the detection of hepatic artery stenosis is 80%-90% (Abbasoglu et al, 1997;Crossin et al, 2003;Kok et al, 1998). Spectral broadening and focal accelerated velocity greater than 2 m/sec (Crossin et al, 2003;Nghiem et al, 1996;Platt et al, 1997) at the site of arterial anastomosis indicate stenosis. However, the site of narrowing is often difficult to identify by US due to overlying bowel gas especially in conduit graft, and the diagnosis is usually made on the basis of the Doppler US findings obtained distal to the stenosis.…”

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“…The value of Doppler ultrasonography in the early diagnosis of vascular complications after liver transplant has been previously established. 1,2 However, the immediate changes in the splanchnic hemodynamics after graft perfusion and the physiologic changes during graft recovery are still under debate. 3 Few reports have investigated early graft hemodynamics by using Doppler ultrasonography after LDLT, with hemodynamics with LDLT influenced by the complex vascular anastomosis and small graft volume compared with deceased-donor liver transplant (DDLT).…”