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Published on: August 14, 2017
Periportal halo on early postoperative CT predicts biliary complications following liver transplantation
Hadrien Lasolle1, François Faitot2, Sébastien Molière3
1Radiology Department, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Insights
A severe periportal halo (PPH) on early post-liver transplant CT scans independently predicts biliary complications. This imaging biomarker triples the risk of complications and sextuples the risk of severe events, aiding risk-adapted follow-up.
Area of Science:
- Hepatobiliary Surgery
- Transplant Imaging
- Radiology
Background:
- Biliary complications are a leading cause of morbidity and graft loss after liver transplantation (LT).
- The prognostic value of periportal halo (PPH) on early post-operative CT for predicting graft dysfunction remains unquantified in contemporary cohorts.
Purpose of the Study:
- To determine if severe PPH on early post-transplant CT independently predicts subsequent biliary complications.
- To explore PPH's utility for risk-adapted follow-up strategies after LT.
Main Methods:
- Retrospective analysis of 133 adult LT recipients' contrast-enhanced abdominal CT scans within 30 days post-transplant.
- Visual grading of PPH by two blinded radiologists; assessment of inter-observer agreement using Cohen's kappa.
- Logistic regression to identify predictors of any biliary complication and severe (Clavien-Dindo grade ≥ III) arterial or biliary events.
Main Results:
- Severe PPH was present in 44% of patients, with excellent inter-observer agreement (κ=0.91).
- Severe PPH independently predicted any biliary complication (aOR=3.51) and severe Clavien-Dindo grade ≥ III events (aOR=5.82).
- Portal-vein stenosis was associated with biliary complications, but hepatic-artery stenosis, ascites, and PPH progression were not significant predictors.
Conclusions:
- Severe PPH on early post-transplant CT is a reproducible imaging biomarker for increased risk of biliary complications.
- This finding can identify high-risk LT patients for intensified monitoring and early intervention.
- Integrating PPH grading into routine reporting allows for tailored surveillance intensity based on objective early imaging risk.
Background:
Biliary complications remain the leading non-vascular cause of morbidity, re-intervention and graft loss after liver transplantation (LT). Previous series have suggested that a "periportal halo" (PPH) on early post-operative CT might herald later graft dysfunction, but its prognostic value has never been quantified in a contemporary cohort.
Purpose:
To determine whether the presence of a severe PPH on the routine early post-transplant CT independently predicts subsequent biliary complications and to explore its potential use for risk-adapted follow-up.
Materials And Methods:
In this retrospective study (institutional review-board waiver, January 2018-December 2019), 133 of 160 consecutive adult LT recipients who underwent contrast-enhanced abdominal CT within 30 days of transplantation were analysed. PPH was graded visually on a four-point scale by two blinded radiologists; inter-observer agreement was assessed with Cohen's κ. Biliary complications were defined a priori as imaging-confirmed strictures, leaks or bilomas accompanied by biochemical cholestasis and/or requiring endoscopic, percutaneous or surgical treatment. Logistic regression identified variables independently associated with (i) any biliary complication and (ii) severe arterial or biliary events requiring Clavien-Dindo grade ≥ III intervention.
Results:
Median interval from LT to CT was 10 days (IQR 5-15). Severe PPH was present in 59/133 patients (44 %); inter-observer agreement was excellent (κ = 0.91). Thirty-two patients (24 %) developed biliary complications during a median follow-up of 14 months (IQR 9-21). In univariate analysis, severe PPH (p = 0.006) and portal-vein stenosis (p = 0.050) were associated with biliary complications. After adjustment for age, MELD score, cold-ischemia time and CT indication, severe PPH remained an independent predictor (adjusted odds ratio [aOR] = 3.51; 95 % CI 1.41-8.76; p = 0.007). Severe arterial or biliary events (Clavien ≥ III, n = 32) were independently predicted by severe PPH as well (aOR = 5.82; 95 % CI 1.70-20.0; p = 0.005), whereas hepatic-artery or portal-anastomotic stenoses, ascites and progression of PPH between serial scans were not significant.
Conclusion:
A severe periportal halo on the first post-operative CT-obtained a median of 10 days after liver transplantation-is a simple, reproducible imaging biomarker that triples the risk of any biliary complication and sextuples the risk of severe Clavien ≥ III arterial or biliary events. Incorporating PPH grading into routine reporting can identify a high-risk subgroup that may benefit from intensified biochemical monitoring, early MRCP and low-threshold therapeutic ERCP, thereby aligning surveillance intensity with objective early-imaging risk.
