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Radiologic findings of biliary complications post liver transplantation

  • Special Section: Benign Biliary Disease
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Liver transplantation is a potentially curative treatment for patients with acute liver failure, end-stage liver disease, and primary hepatic malignancy. Despite tremendous advancements in surgical techniques and immunosuppressive management, there remains a high rate of post-transplant complications, with one of the main complications being biliary complications. In addition to anastomotic leak and stricture, numerous additional biliary complications are encountered, including ischemic cholangiopathy due to the sole arterial supply of the bile ducts, recurrence of primary biliary disease, infections, biliary obstruction from stones, cast, or hemobilia, and less commonly cystic duct remnant mucocele, vanishing duct syndrome, duct discrepancy and kinking, post-transplant lymphoproliferative disorder, retained stent, and ampullary dysfunction. This article presents an overview of biliary anatomy and surgical techniques in liver transplantation, followed by a detailed review of post-transplant biliary complications with their corresponding imaging findings on multiple modalities with emphasis on magnetic resonance imaging and MR cholangiopancreatography.

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Abbreviations

CT:

Computed tomography

CHD:

Common hepatic duct

CBD:

Common bile duct

ERCP:

Endoscopic retrograde cholangiopancreatography

FASE:

Fast advanced spin echo

HASTE:

Half-Fourier acquisition single-shot turbo spin echo imaging

HIDA:

Hepatobiliary scintigraphy

LDLT:

Living donor liver transplant

LHD:

Left hepatic duct

MRI:

Magnetic resonance imaging

MRCP:

Magnetic resonance cholangiopancreatography

MIP:

Maximum intensity projection

OLT:

Orthotopic liver transplant

PTC:

Percutaneous transhepatic cholangiogram

PTLD:

Post-transplant lymphoproliferative disorder

PBC:

Primary biliary cholangitis

PSC:

Primary sclerosing cholangitis

RAHD:

Right anterior hepatic duct

RPHD:

Right posterior hepatic duct

RHD:

Right hepatic duct

RARE:

Rapid acquisition with relaxation enhancement

SSFSE:

Single-shot fast spin echo

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Authors and Affiliations

  1. Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA

    Rachita Khot

  2. Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA

    Matthew A. Morgan

  3. Department of Radiology, University of Kentucky, Lexington, KY, USA

    Rashmi T. Nair

  4. Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA

    Daniel R. Ludwig & Malak Itani

  5. Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA

    Hina Arif-Tiwari

  6. Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA

    Chandra S. Bhati

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Khot, R., Morgan, M.A., Nair, R.T. et al. Radiologic findings of biliary complications post liver transplantation. Abdom Radiol 48, 166–185 (2023). https://doi.org/10.1007/s00261-022-03714-y

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