Advances in Transplantology
Liver transplantation
Clinical Utility of Hepatic-Perfusion Computerized Tomography in Living-Donor Liver Transplantation: A Preliminary Study

https://doi.org/10.1016/j.transproceed.2014.11.038Get rights and content

Highlights

  • We evaluated patients who had received transplants in our hospital or outside institutions and were referred to the diagnostic radiology department for further evaluation of vascular complications by means of CT perfusion.

  • We aimed to evaluate the diagnostic and prognostic value of CT perfusion in detecting vascular complications in liver grafts.

  • CT perfusion imaging enabled an analysis of vascular regions, a functional assessment of the liver graft parenchyma, and a quantitative evaluation of the areas in the liver parenchyma affected by vascular complications.

  • Unlike other imaging techniques, such as Doppler ultrasound and CT angiography, this method may have the potential role to predict treatment responses and liver graft life expectancy.

Abstract

Background

Vascular complications are a primary diagnostic consideration in liver transplant recipients, with an overall incidence of 9%. Cross-sectional imaging techniques provide information regarding vascular structure and luminal patency but can not quantitatively assess hepatocyte damage in the liver graft parenchyma. Perfusion computerized tomography (CT) is a recently developed method that allows for quantitative evaluation of hemodynamic changes in tissue. Our objective was to evaluate the clinical utility of perfusion CT in assessing vascular complications during living-donor liver transplantation (LDLT).

Methods

The 33 recipients were divided into 3 groups according to Doppler ultrasonographic findings: hepatic arterial complication group, portal venous complication group, and hepatic venous complication group. Blood volume (BV), blood flow (BF), arterial liver perfusion (ALP), portal venous perfusion (PVP), and hepatic perfusion index (HPI) were calculated for the affected vascular territory regions.

Results

Compared with normal liver parenchyma, BV, BF, ALP, and HPI were significantly lower in the hepatic arterial complication group. Although PVP and BV were significantly lower, ALP, HPI, and BF were higher in the affected vascular territory region than in normal liver parenchyma for the portal venous complication group. In the hepatic venous complication group, PVP was significantly higher and BF, ALP, and HPI significantly lower in the affected vascular territory regions than in normal liver parenchyma.

Conclusions

Perfusion CT imaging is a noninvasive technique that enables the quantitative evaluation of vascular complications in the graft parenchyma after LDLT and permits a quantitative evaluation of the treatment response.

Section snippets

Patients

This prospective study was conducted from August 2012 to March 2014. Institutional Review Board approval was received, and every patient gave written informed consent. Thirty-nine right-lobe liver graft transplant recipients (21 men and 18 women; mean age, 53 ± 7.4 years; age range, 43–68 years) who had undergone transplantation in our hospital or outside institutions were referred to the diagnostic radiology department for further evaluation of vascular complications diagnosed by means of

Results

All the patients with post-transplantation vascular complications successfully underwent perfusion CT imaging. The post-transplantation vascular complications are summarized in Table 1. There were no statistically significant differences in age (F: 2.647; P > .05) or sex (P > .05) distribution between the arterial and portal and hepatic venous complication groups.

The comparisons of the mean pre- and post-treatment perfusion parameters between the affected vascular territory regions and normal

Discussion

In post-transplantation liver tissue, it is essential to determine whether parenchymal necrosis, ischemia, biliary abscesses, or regional extensions are present [18], [19], [20]. Early diagnosis is crucial for successful management of these complications, and imaging plays an important role in the diagnosis of complications [1], [2], [7]. When vascular complications occur after liver transplantation, the transplantation surgeons need information regarding the following:

  • Which vascular structure

Study Limitations

Our study had a few limitations. First, the cohort was relatively small. Therefore, the cutoff values for the hepatic arterial and hepatic venous complication groups must be confirmed in larger prospective studies. Perfusion CT imaging enables the quantitative evaluation of vascular complications in the graft parenchyma after LDLT and permits a quantitative evaluation of treatment response. More cases should be collected, and more data should be validated. Second, standard cutoff values for the

Conclusion

Perfusion CT imaging enabled an analysis of vascular regions, a functional assessment of the liver graft parenchyma, and a quantitative evaluation of the areas in the liver parenchyma affected by vascular complications. Moreover, it can assist with early detection of changes in hepatic perfusion and thus with early commencement of treatment. Unlike other imaging techniques, such as Doppler US and CT angiography, this method may have a potential role in predicting treatment responses and liver

References (30)

  • Y. Tsushima et al.

    Quantitative perfusion map of malignant liver tumors, created from dynamic computed tomography data

    Acad Radiol

    (2004)
  • A.N. Langnas et al.

    Vascular complications after orthotopic liver transplantation

    Am J Surg

    (1991)
  • S. Quiroga et al.

    Complications of orthotopic liver transplantation: spectrum of findings with helical CT

    Radiographics

    (2001)
  • B.K. Hom et al.

    Prospective evaluation of vascular complications after liver transplantation: comparison of conventional and microbubble contrast-enhanced US

    Radiology

    (2006)
  • B.S. Kim et al.

    Vascular complications after living related liver transplantation: evaluation with gadolinium-enhanced three-dimensional MR angiography

    AJR Am J Roentgenol

    (2003)
  • E.Y. Ko et al.

    Hepatic vein stenosis after living donor liver transplantation: evaluation with Doppler US

    Radiology

    (2003)
  • H.V. Nghiem

    Imaging of hepatic transplantation

    Radiol Clin North Am

    (1998)
  • Z.G. Zhuang et al.

    Computed tomography perfusion in living donor liver transplantation: an initial study of normal hemodynamic changes in liver grafts

    Clin Transplant

    (2009)
  • E.L. Nickoloff et al.

    A comparative study of thoracic radiation doses from 64-slice cardiac CT

    Br J Radiol

    (2007)
  • A. Vit et al.

    Doppler evaluation of arterial complications of adult orthotopic liver transplantation

    J Clin Ultrasound

    (2003)
  • S. Rossi et al.

    Contrast-enhanced versus conventional and color Doppler sonography for the detection of thrombosis of the portal and hepatic venous systems

    AJR Am J Roentgenol

    (2006)
  • J.D. Crossin et al.

    US of liver transplants: normal and abnormal

    Radiographics

    (2003)
  • P.S. Sidhu et al.

    Microbubble ultrasound contrast in the assessment of hepatic artery patency following liver transplantation: role in reducing frequency of hepatic artery arteriography

    Eur Radiol

    (2004)
  • D.Z. Bao et al.

    64-slice spiral perfusion CT combined with vascular imaging of acute ischemic stroke for assessment of infarct core and penumbra

    Exp Ther Med

    (2013)
  • K. Hayano et al.

    Quantitative characterization of hepatocellular carcinoma and metastatic liver tumor by perfusion CT

    Cancer Imaging

    (2013)
  • View full text