Skip to main content

Imaging of Liver Transplant

  • Chapter
  • First Online:
Cross-Sectional Imaging of the Abdomen and Pelvis

Abstract

The diagnostic evaluation for liver transplantation begins in the preoperative period in identification of the disease processes in the liver, the presence of metastases, and the assessment of variant anatomy.

Preoperative imaging is paramount as it allows the determination of candidacy for transplantation and will identify potential difficult anatomy for the transplant team.

After liver transplantation, a multi-modality diagnostic approach can be utilized in the assessment of various conditions complicating liver transplantation. Arterial, venous, biliary, and portal venous complications can occur. The initial imaging modality and further diagnostic work up vary based on which system is involved.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Abbasoglu O. Liver transplantation: yesterday, today and tomorrow. World J Gastroenterol. 2008;14(20):3117–22.

    PubMed  PubMed Central  Google Scholar 

  2. Garcia-Criado A, et al. Radiology in liver transplantation. Semin Ultrasound CT MR. 2002;23(1):114–29.

    PubMed  Google Scholar 

  3. Clavien PA, Lesurtel M, Bossuyt PM, Gores GJ, Langer B, Perrier A, OLT for HCC Consensus Group. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13(1):e11–22. Epub 2011 Oct 31.

    PubMed  Google Scholar 

  4. Moon DB, Lee SG. Liver transplantation. Gut Liver. 2009;3(3):145–65.

    PubMed  PubMed Central  Google Scholar 

  5. Mazzaferro V, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693–9.

    CAS  PubMed  Google Scholar 

  6. Keeffe E. Selection of patients for liver transplantation. In: Schiff ER, Maddrey WC, Sorrell MF, editors. Transplantation of the liver. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 5–34.

    Google Scholar 

  7. Lee SY, et al. Living donor liver transplantation: complications in donors and interventional management. Radiology. 2004;230(2):443–9.

    PubMed  Google Scholar 

  8. Kamel IR, Lawler LP, Fishman EK. Variations in anatomy of the middle hepatic vein and their impact on formal right hepatectomy. Abdom Imaging. 2003;28(5):668–74.

    CAS  PubMed  Google Scholar 

  9. Casavilla A, Giles GR, Starzl TE. Techniques of liver transplantation. In: Blumgart L, editor. Surgery of the liver, biliary tract, and pancreas. Philadelphia: Saunders; 2006.

    Google Scholar 

  10. Winter 3rd TC, et al. Hepatic arterial anatomy in transplantation candidates: evaluation with three-dimensional CT arteriography. Radiology. 1995;195(2):363–70.

    PubMed  Google Scholar 

  11. Smith PA, et al. Dual-phase spiral CT angiography with volumetric 3D rendering for preoperative liver transplant evaluation: preliminary observations. J Comput Assist Tomogr. 1998;22(6):868–74.

    CAS  PubMed  Google Scholar 

  12. Fan ST. Donor safety in living donor liver transplantation. Liver Transpl. 2000;6(2):250–1.

    CAS  PubMed  Google Scholar 

  13. Nghiem HV, et al. Evaluation of the portal venous system before liver transplantation: value of phase-contrast MR angiography. AJR Am J Roentgenol. 1995;164(4):871–8.

    CAS  PubMed  Google Scholar 

  14. Low G, et al. Imaging evaluation of potential donors in living-donor liver transplantation. Clin Radiol. 2008;63(2):136–45.

    CAS  PubMed  Google Scholar 

  15. Nghiem HV. Imaging of hepatic transplantation. Radiol Clin North Am. 1998;36(2):429–43.

    CAS  PubMed  Google Scholar 

  16. Mori K, et al. The introduction of microvascular surgery to hepatic artery reconstruction in living-donor liver transplantation–its surgical advantages compared with conventional procedures. Transplantation. 1992;54(2):263–8.

    CAS  PubMed  Google Scholar 

  17. Berrocal T, et al. Pediatric liver transplantation: a pictorial essay of early and late complications. Radiographics. 2006;26(4):1187–209.

    PubMed  Google Scholar 

  18. Sugawara Y, Makuuchi M. Technical advances in living-related liver transplantation. J Hepatobiliary Pancreat Surg. 1999;6(3):245–53.

    CAS  PubMed  Google Scholar 

  19. Kurtz AB, Rubin CS, Cooper HS, et al. Ultra- sound findings in hepatitis. Radiology. 1980;136(3):717–23.

    CAS  PubMed  Google Scholar 

  20. Sanyal R, et al. Orthotopic liver transplantation: reversible doppler US findings in the immediate postoperative period. Radiographics. 2012;32:199.

    PubMed  Google Scholar 

  21. Stell D, Downey D, Marotta P, et al. Prospective evaluation of the role of quantitative Doppler ultrasound surveillance in liver transplantation. Liver Transpl. 2004;10(9):1183–8.

    PubMed  Google Scholar 

  22. Garcia-Criado A, et al. Significance of and contributing factors for a high resistive index on Doppler sonography of the hepatic artery immediately after surgery: prognostic implications for liver transplant recipients. AJR Am J Roentgenol. 2003;181(3):831–8.

    PubMed  Google Scholar 

  23. García-Criado A, Gilabert R, Berzigotti A, Brú C. Doppler ultrasound findings in the hepatic artery shortly after liver transplantation. AJR Am J Roentgenol. 2009;193(1):128–35.

    PubMed  Google Scholar 

  24. Chen W, Facciuto ME, Rocca JP, et al. Doppler ultrasonographic findings on hepatic arterial vasospasm early after liver transplantation. J Ultrasound Med. 2006;25(5):631–8.

    PubMed  Google Scholar 

  25. Lautt WW. Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. Am J Physiol. 1985;249(5 pt 1):G549–56.

    CAS  PubMed  Google Scholar 

  26. Quintini C, Hirose K, Hashimoto K, et al. “Splenic artery steal syndrome” is a misnomer: the cause is portal hyperperfusion, not arterial siphon. Liver Transpl. 2008;14(3):374–9.

    PubMed  Google Scholar 

  27. Platt JF, Yutzy GG, Bude RO, et al. Use of Doppler sonography for revealing hepatic artery stenosis in liver transplant recipients. AJR Am J Roentgenol. 1997;168(2):473–6.

    CAS  PubMed  Google Scholar 

  28. Dodd 3rd GD, et al. Hepatic artery stenosis and thrombosis in transplant recipients: Doppler diagnosis with resistive index and systolic acceleration time. Radiology. 1994;192(3):657–61.

    PubMed  Google Scholar 

  29. Chong WK, Beland JC, Weeks SM. Sonographic evaluation of venous obstruction in liver trans- plants. AJR Am J Roentgenol. 2007;188(6):W515–21.

    PubMed  Google Scholar 

  30. Bolognesi M, Sacerdoti D, Bombonato G, et al. Change in portal flow after liver transplantation: effect on hepatic arterial resistance indices and role of spleen size. Hepatology. 2002;35(3):601–8.

    PubMed  Google Scholar 

  31. Vit A, et al. Doppler evaluation of arterial complications of adult orthotopic liver transplantation. J Clin Ultrasound. 2003;31(7):339–45.

    PubMed  Google Scholar 

  32. Crossin JD, Muradali D, Wilson SR. US of liver transplants: normal and abnormal. Radiographics. 2003;23(5):1093–114.

    PubMed  Google Scholar 

  33. Lallier M, et al. Vascular complications after pediatric liver transplantation. J Pediatr Surg. 1995;30(8):1122–6.

    CAS  PubMed  Google Scholar 

  34. Sarfati PO, et al. Acute hepatic artery thrombosis in pediatric liver transplantation: surgical thrombectomy and in situ fibrinolysis. Ann Chir. 1992;46(7):605–9.

    CAS  PubMed  Google Scholar 

  35. Segel MC, et al. Hepatic artery thrombosis after liver transplantation: radiologic evaluation. AJR Am J Roentgenol. 1986;146(1):137–41.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. Blumhardt G, et al. Vascular problems in liver transplantation. Transplant Proc. 1987;19(1 Pt 3):2412.

    CAS  PubMed  Google Scholar 

  37. Pawlak J, et al. Vascular complications after liver transplantation. Transplant Proc. 2003;35(6):2313–5.

    CAS  PubMed  Google Scholar 

  38. Moray G, et al. Vascular complications after liver transplantation in pediatric patients. Transplant Proc. 2005;37(7):3200–2.

    CAS  PubMed  Google Scholar 

  39. Orons PD, Sheng R, Zajko AB. Hepatic artery stenosis in liver transplant recipients: prevalence and cholangiographic appearance of associated biliary complications. AJR Am J Roentgenol. 1995;165(5):1145–9.

    CAS  PubMed  Google Scholar 

  40. Cook GJ, Crofton ME. Hepatic artery thrombosis and infarction: evolution of the ultrasound appearances in liver transplant recipients. Br J Radiol. 1997;70:248–51.

    CAS  PubMed  Google Scholar 

  41. Tamsel S, et al. Vascular complications after liver transplantation: evaluation with Doppler US. Abdom Imaging. 2007;32(3):339–47.

    PubMed  Google Scholar 

  42. Hom BK, et al. Prospective evaluation of vascular complications after liver transplantation: comparison of conventional and microbubble contrast-enhanced US. Radiology. 2006;241(1):267–74.

    PubMed  Google Scholar 

  43. Nghiem HV, et al. Imaging of complications in liver transplantation. Radiographics. 1996;16(4):825–40.

    CAS  PubMed  Google Scholar 

  44. Amesur NB, Zajko AB. Interventional radiology in liver transplantation. Liver Transpl. 2006;12(3):330–51.

    PubMed  Google Scholar 

  45. Boyvat F, et al. Diagnostic and therapeutic management of hepatic artery thrombosis and stenosis after orthotopic and heterotopic liver transplantation. Transplant Proc. 2003;35(7):2791–5.

    CAS  PubMed  Google Scholar 

  46. Vignali C, et al. Diagnosis and treatment of hepatic artery stenosis after orthotopic liver transplantation. Transplant Proc. 2004;36(9):2771–3.

    CAS  PubMed  Google Scholar 

  47. Raby N, et al. Stenoses of vascular anastomoses after hepatic transplantation: treatment with balloon angioplasty. AJR Am J Roentgenol. 1991;157(1):167–71.

    CAS  PubMed  Google Scholar 

  48. Boyvat F, et al. Endovascular stent placement in patients with hepatic artery stenoses or thromboses after liver transplant. Transplant Proc. 2008;40(1):22–6.

    CAS  PubMed  Google Scholar 

  49. Quiroga S, et al. Complications of orthotopic liver transplantation: spectrum of findings with helical CT. Radiographics. 2001; 21(5):1085–102.

    CAS  PubMed  Google Scholar 

  50. Bechstein WO, et al. Surgical complications in 200 consecutive liver transplants. Transplant Proc. 1987;19(5):3830–1.

    CAS  PubMed  Google Scholar 

  51. Sheng R, et al. Dissecting pseudoaneurysm of the hepatic artery: a delayed complication of angioplasty in a liver transplant. Cardiovasc Intervent Radiol. 1995;18(2):112–4.

    CAS  PubMed  Google Scholar 

  52. Karatzas T, et al. Vascular complications, treatment, and outcome following orthotopic liver transplantation. Transplant Proc. 1997;29(7):2853–5.

    CAS  PubMed  Google Scholar 

  53. Maleux G, et al. Case report: hepatic artery pseudoaneurysm after liver transplantation: definitive treatment with a stent-graft after failed coil embolisation. Br J Radiol. 2005;78(929):453–6.

    CAS  PubMed  Google Scholar 

  54. Muraoka N, et al. Covered coronary stent graft in the treatment of hepatic artery pseudoaneurysm after liver transplantation. J Vasc Interv Radiol. 2005;16(2 Pt 1):300–2.

    PubMed  Google Scholar 

  55. Lee J, et al. Extrahepatic portal vein stenosis in recipients of living-donor allografts: Doppler sonography. AJR Am J Roentgenol. 1996;167(1):85–90.

    CAS  PubMed  Google Scholar 

  56. Holbert BL, Campbell WL, Skolnick ML. Evaluation of the transplanted liver and postoperative complications. Radiol Clin North Am. 1995;33(3):521–40.

    CAS  PubMed  Google Scholar 

  57. Lerut J, et al. Complications of venous reconstruction in human orthotopic liver transplantation. Ann Surg. 1987;205(4):404–14.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Buell JF, et al. Long-term venous complications after full-size and segmental pediatric liver transplantation. Ann Surg. 2002;236(5):658–66.

    PubMed  PubMed Central  Google Scholar 

  59. Finn JP, et al. Liver transplantation: MR angiography with surgical validation. Radiology. 1991;179(1):265–9.

    CAS  PubMed  Google Scholar 

  60. Funaki B, et al. Angioplasty treatment of portal vein stenosis in children with segmental liver transplants: mid-term results. AJR Am J Roentgenol. 1997;169(2):551–4.

    CAS  PubMed  Google Scholar 

  61. Friedewald SM, et al. Vascular and nonvascular complications of liver transplants: sonographic evaluation and correlation with other imaging modalities and findings at surgery and pathology. Ultrasound Q. 2003;19(2):71–85; quiz 108–10.

    PubMed  Google Scholar 

  62. Spada M, et al. Pediatric liver transplantation. World J Gastroenterol. 2009;15(6):648–74.

    PubMed  PubMed Central  Google Scholar 

  63. Stafford-Johnson DB, et al. Vascular complications of liver transplantation: evaluation with gadolinium-enhanced MR angiography. Radiology. 1998;207(1):153–60.

    CAS  PubMed  Google Scholar 

  64. Pieters PC, Miller WJ, DeMeo JH. Evaluation of the portal venous system: complementary roles of invasive and noninvasive imaging strategies. Radiographics. 1997;17(4):879–95.

    CAS  PubMed  Google Scholar 

  65. McDaniel HM, et al. Intraoperative placement of a Wallstent for portal vein stenosis and thrombosis after liver transplantation. Transplantation. 1997;63(4):607–8.

    CAS  PubMed  Google Scholar 

  66. Haskal ZJ, Naji A. Treatment of portal vein thrombosis after liver transplantation with percutaneous thrombolysis and stent placement. J Vasc Interv Radiol. 1993;4(6):789–92.

    CAS  PubMed  Google Scholar 

  67. Ciccarelli O, et al. Transjugular intrahepatic portosystemic shunt approach and local thrombolysis for treatment of early posttransplant portal vein thrombosis. Transplantation. 2001;72(1):159–61.

    CAS  PubMed  Google Scholar 

  68. Ferraz-Neto BH, et al. Portal vein aneurysm as late complication of liver transplantation: a case report. Transplant Proc. 2004;36(4):970–1.

    CAS  PubMed  Google Scholar 

  69. Blasbalg R, Yamada RM, Tiferes DA. Extrahepatic portal vein aneurysms. AJR Am J Roentgenol. 2000;174(3):877.

    CAS  PubMed  Google Scholar 

  70. Ozbek SS, et al. Portal venous system aneurysms: report of five cases. J Ultrasound Med. 1999;18(6):417–22; quiz 423.

    CAS  PubMed  Google Scholar 

  71. Brouwers MA, et al. Inferior vena cava obstruction after orthotopic liver transplantation. Clin Transplant. 1994;8(1):19–22.

    CAS  PubMed  Google Scholar 

  72. Cheng YF, et al. Angioplasty treatment of hepatic vein stenosis in pediatric liver transplants: long-term results. Transpl Int. 2005;18(5):556–61.

    PubMed  Google Scholar 

  73. Zulke C, et al. Detection of suprahepatic caval stenosis following liver transplantation and treatment via balloon-expandable intravascular stent. Transpl Int. 1995;8(4):330–2.

    CAS  PubMed  Google Scholar 

  74. Berger H, et al. Balloon dilatation and stent placement of suprahepatic caval anastomotic stenosis following liver transplantation. Cardiovasc Intervent Radiol. 1993;16(6):384–7.

    CAS  PubMed  Google Scholar 

  75. Wang SL, et al. Treatment of hepatic venous outflow obstruction after piggyback liver transplantation. Radiology. 2005;236(1):352–9.

    PubMed  Google Scholar 

  76. Navarro F, et al. Specific vascular complications of orthotopic liver transplantation with preservation of the retrohepatic vena cava: review of 1361 cases. Transplantation. 1999;68(5):646–50.

    CAS  PubMed  Google Scholar 

  77. Pfammatter T, et al. Suprahepatic caval anastomotic stenosis complicating orthotopic liver transplantation: treatment with percutaneous transluminal angioplasty, Wallstent placement, or both. AJR Am J Roentgenol. 1997;168(2):477–80.

    CAS  PubMed  Google Scholar 

  78. Orons PD, et al. Thrombolysis and endovascular stent placement for inferior vena caval thrombosis in a liver transplant recipient. Transplantation. 1997;64(9):1357–61.

    CAS  PubMed  Google Scholar 

  79. Pascher A, Neuhaus P. Bile duct complications after liver transplantation. Transpl Int. 2005;18(6):627–42.

    PubMed  Google Scholar 

  80. Verdonk RC, et al. Biliary complications after liver transplantation: a review. Scand J Gastroenterol Suppl. 2006;243:89–101.

    Google Scholar 

  81. Valls C, et al. Biliary complications after liver transplantation: diagnosis with MR cholangiopancreatography. AJR Am J Roentgenol. 2005;184(3):812–20.

    PubMed  Google Scholar 

  82. Girometti R, et al. Biliary complications after orthotopic liver transplantation: MRCP findings. Abdom Imaging. 2008;33(5):542–54.

    PubMed  Google Scholar 

  83. Haberal M. Liver transplantation: experience at our center. Transplant Proc. 2006;38(7):2111–6.

    CAS  PubMed  Google Scholar 

  84. Beltran MM, et al. Accuracy of magnetic resonance cholangiography in the evaluation of late biliary complications after orthotopic liver transplantation. Transplant Proc. 2005;37(9):3924–5.

    PubMed  Google Scholar 

  85. Fulcher AS, Turner MA, Capps GW. MR cholangiography: technical advances and clinical applications. Radiographics. 1999;19(1):25–41; discussion 41–4.

    CAS  PubMed  Google Scholar 

  86. Fulcher AS, Turner MA. Orthotopic liver transplantation: evaluation with MR cholangiography. Radiology. 1999;211(3):715–22.

    CAS  PubMed  Google Scholar 

  87. Greif F, et al. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg. 1994;219(1):40–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  88. Laghi A, et al. MR cholangiography of late biliary complications after liver transplantation. AJR Am J Roentgenol. 1999;172(6):1541–6.

    CAS  PubMed  Google Scholar 

  89. Sheng R, et al. Biliary stones and sludge in liver transplant patients: a 13-year experience. Radiology. 1996;198(1):243–7.

    CAS  PubMed  Google Scholar 

  90. Keogan MT, et al. The role of imaging in the diagnosis and management of biliary complications after liver transplantation. AJR Am J Roentgenol. 1999;173(1):215–9.

    CAS  PubMed  Google Scholar 

  91. Gautam M, Cheruvattath R, Balan V. Recurrence of autoimmune liver disease after liver transplantation: a systematic review. Liver Transpl. 2006;12(12):1813–24.

    PubMed  Google Scholar 

  92. Duclos-Vallee JC, Sebagh M. Recurrence of autoimmune disease, primary sclerosing cholangitis, primary biliary cirrhosis, and autoimmune hepatitis after liver transplantation. Liver Transpl. 2009;15 Suppl 2:S25–34.

    PubMed  Google Scholar 

  93. Shah AN, Dodson F, Fung J. Role of nuclear medicine in liver transplantation. Semin Nucl Med. 1995;25(1):36–48.

    CAS  PubMed  Google Scholar 

  94. Aseni P, et al. De novo cancers and post-transplant lymphoproliferative disorder in adult liver transplantation. Pathol Int. 2006;56(11):712–5.

    PubMed  Google Scholar 

  95. Strouse PJ, et al. Tumorous intrahepatic lymphoproliferative disorder in transplanted livers. AJR Am J Roentgenol. 1996;167(5):1159–62.

    CAS  PubMed  Google Scholar 

  96. Mazariegos GV, Molmenti EP, Kramer DJ. Early complications after orthotopic liver transplantation. Surg Clin North Am. 1999;79(1):109–29.

    CAS  PubMed  Google Scholar 

  97. Pandharipande PV, et al. Vascular and extravascular complications of liver transplantation: comprehensive evaluation with three-dimensional contrast-enhanced volumetric MR imaging and MR cholangiopancreatography. AJR Am J Roentgenol. 2001;177(5):1101–7.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Khaled M. Elsayes MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Asran, M.K., Kanaan, Y., Goenka, A.H., Elsayes, K.M. (2015). Imaging of Liver Transplant. In: Elsayes, K.M. (eds) Cross-Sectional Imaging of the Abdomen and Pelvis. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1884-3_22

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1884-3_22

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1883-6

  • Online ISBN: 978-1-4939-1884-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics