The role of the radiologist in liver transplantation

The radiologist is an important member of the liver transplant team. His main pre-operative role is to detect abnormalities which may preclude transplantation or alter the standard surgical approach in patients. Colour Doppler ultrasound and computerised tomography (CT) are the primary imaging methods utilised pre-operatively. Knowledge of the surgical procedure employed is essential and comprises four basic vascular anastomoses, namely: supra- and infra- inferior vena cava, portal vein and hepatic artery. In the immediate post-transplant period, hepatic artery thrombosis is the most common vascular complication. The radiologist plays a major role in the diagnosis and management of vascular and biliary complications, as well as the assessment and treatment of fluid collections. The current status of imaging graft rejection remains uncertain. Doppler ultrasound and direct cholangiography are the most frequent post-operative investigations. Emphasis is placed on early radiological evaluation of complications leading to graft failure, patient morbidity and mortality, so as to enable institution of the appropriate surgical or radiological interventional procedure.