Related Experiment Videos
Imaging of vascular complications after hepatic transplantation
1Department of Radiology, University of Minnesota Hospital and Clinic, Minneapolis 55455.
Insights
Noninvasive imaging like sonography and CT aids in detecting vascular complications after liver transplants. However, angiography remains essential for definitive diagnosis and treatment planning in these critical cases.
Area of Science:
- Hepatology
- Vascular Surgery
- Radiology
Background:
- Vascular complications significantly impact liver transplant graft and patient survival.
- Angiography is established for revascularization/retransplantation decisions, but noninvasive imaging's role is unclear.
Purpose of the Study:
- To evaluate the diagnostic value of noninvasive imaging techniques for vascular complications post-liver transplantation.
- To compare the efficacy of sonography, scintigraphy, CT, and MR imaging in identifying specific vascular issues.
Main Methods:
- Retrospective review of 19 major vascular complications in 98 liver recipients over 3.5 years.
- Analysis of diagnostic accuracy for sonography, CT, scintigraphy, and MR imaging.
Main Results:
- Portal venous thrombosis (7), arterial thrombosis (7), and IVC thrombosis (5) were identified.
- Sonography initially diagnosed PVT (3), arterial compromise (5), and IVC obstruction (4).
- CT identified PV occlusion (2), donor aortic thrombosis (1), and IVC thrombosis (1).
Conclusions:
- Sonography and CT are valuable for initial assessment of post-liver transplant vascular complications.
- Neither sonography nor CT is sensitive enough to replace angiography for definitive diagnosis.
Abstract:
Vascular complications after hepatic transplantation can compromise graft and patient survival. Angiography defines the need for revascularization or retransplantation, but the value of noninvasive imaging in this setting is not clear. To assess the relative merit of noninvasive imaging techniques (sonography, scintigraphy, CT, and MR), we retrospectively reviewed 19 major vascular complications that occurred in 15 of 98 hepatic recipients over a 3 1/2-year period. Portal venous thrombosis was seen in seven patients, donor aortic or hepatic arterial thrombosis in seven, and inferior vena caval thrombosis in five. Sonography provided the initial diagnosis of portal venous thrombosis in three, arterial compromise in five, and caval obstruction in four. CT was the first diagnostic examination to identify portal occlusion in two, donor aortic thrombosis in one, and inferior vena caval thrombosis in one. Scintigraphy and MR imaging provided complementary data. Both sonography and CT are useful in the evaluation of vascular complications that occur after hepatic transplantation; however, neither is sufficiently sensitive to obviate angiographic assessment.