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Hepatic Transplantation
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Whole-liver allograft (cadaver donor)
          • Orthotopic liver transplantation (OLT)
          • Included from donor
            • Intact inferior vena cava (IVC): Anastomosed end-to-end or as "piggyback" side-to-side
            • Hepatic artery (HA): Anastomosed end-to-end, sometimes with aortic (Carrel) patch
            • Portal vein (PV): End-to-end anastomosis
            • Bile duct: Anastomosed end-to-end with recipient duct (70%) or to Roux limb
        • Cadaver split liver (2 halves to separate recipients)
          • Right lobe to adult recipient (IVC, HA, PV, bile duct)
          • Left lobe to child recipient (complex anastomoses)
        • Living donor transplant
          • Child recipient: Generally receives lateral segment of donor liver
          • Adult recipient: Receives right lobe of donor liver
          • Complex biliary and vascular anastomoses

      IMAGING

      • Imaging Recommendations

        • Normal Posttransplantation Findings

          • Pretransplantation Evaluation

            • Allograft Rejection

              • Biliary Complications

                • Vascular Complications

                  • Recurrent Disease Within Allograft

                    • Extrahepatic Complications

                      CLINICAL ISSUES

                      • Natural History & Prognosis

                        DIAGNOSTIC CHECKLIST

                        • Image Interpretation Pearls

                          Selected References

                          1. Horrow MM et al: Complications after liver transplant related to preexisting conditions: diagnosis, treatment, and prevention. Radiographics. 40(3):895-909, 2020
                          2. Sannananja B et al: Tricky findings in liver transplant imaging: a review of pitfalls with solutions. Curr Probl Diagn Radiol. 47(3):179-88, 2018
                          3. Girometti R et al: Imaging of liver transplantation. Eur J Radiol. 93:295-307, 2017
                          4. Baheti AD et al: Surgical techniques and imaging complications of liver transplant. Radiol Clin North Am. 54(2):199-215, 2016
                          5. Lai Q et al: Hepatocellular cancer: how to expand safely inclusion criteria for liver transplantation. Curr Opin Organ Transplant. 19(3):229-34, 2014
                          6. Song GW et al: Living donor liver transplantation. Curr Opin Organ Transplant. 19(3):217-22, 2014
                          7. Liu YI et al: Multidetector computed tomography triphasic evaluation of the liver before transplantation: importance of equilibrium phase washout and morphology for characterizing hypervascular lesions. J Comput Assist Tomogr. 36(2):213-9, 2012
                          8. Singh AK et al: Imaging of preoperative liver transplantation in adults: what radiologists should know. Radiographics. 31(4):1017-30, 2011
                          9. Miraglia R et al: Interventional radiology procedures in pediatric patients with complications after liver transplantation. Radiographics. 29(2):567-84, 2009
                          10. Chen HL et al: Diagnosis and interventional radiological treatment of vascular and biliary complications after liver transplantation in children with biliary atresia. Transplant Proc. 40(8):2534-6, 2008
                          11. Ko GY et al: Early posttransplant hepatic venous outflow obstruction: long-term efficacy of primary stent placement. Liver Transpl. 14(10):1505-11, 2008
                          12. Caiado AH et al: Complications of liver transplantation: multimodality imaging approach. Radiographics. 27(5):1401-17, 2007
                          13. Zhang BL et al: Early sonographic assessment of Budd-Chiari syndrome after orthotopic liver transplantation. J Clin Ultrasound. 35(8):458-61, 2007
                          14. Berrocal T et al: Pediatric liver transplantation: a pictorial essay of early and late complications. Radiographics. 26(4):1187-209, 2006
                          15. Nishida S et al: Intrahepatic biliary strictures after liver transplantation. J Hepatobiliary Pancreat Surg. 13(6):511-6, 2006
                          16. Shin JH et al: Endovascular stent placement for interposed middle hepatic vein graft occlusion after living-donor liver transplantation using right-lobe graft. Liver Transpl. 12(2):269-76, 2006
                          17. Thuluvath PJ et al: Biliary complications after liver transplantation: the role of endoscopy. Endoscopy. 37(9):857-63, 2005
                          18. Wang SL et al: Treatment of hepatic venous outflow obstruction after piggyback liver transplantation. Radiology. 236(1):352-9, 2005
                          19. Boraschi P et al: Complications of orthotopic liver transplantation: imaging findings. Abdom Imaging. 29(2):189-202, 2004
                          20. Huang DZ et al: The value of color Doppler ultrasonography in monitoring normal orthotopic liver transplantation and postoperative complications. Hepatobiliary Pancreat Dis Int. 2(1):54-8, 2003
                          21. Ko GY et al: Endovascular treatment of hepatic venous outflow obstruction after living-donor liver transplantation. J Vasc Interv Radiol. 13(6):591-9, 2002
                          22. Cheng YF et al: Interventional radiologic procedures in liver transplantation. Transpl Int. 14(4):223-9, 2001
                          23. Inomata Y et al: Pathogenesis and treatment of bile duct loss after liver transplantation. J Hepatobiliary Pancreat Surg. 8(4):316-22, 2001
                          24. Barton P et al: Biliary sludge after liver transplantation: 2. Treatment with interventional techniques versus surgery and/or oral chemolysis. AJR Am J Roentgenol. 164(4):865-9, 1995
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Imaging

                              TERMINOLOGY

                              • Definitions

                                • Whole-liver allograft (cadaver donor)
                                  • Orthotopic liver transplantation (OLT)
                                  • Included from donor
                                    • Intact inferior vena cava (IVC): Anastomosed end-to-end or as "piggyback" side-to-side
                                    • Hepatic artery (HA): Anastomosed end-to-end, sometimes with aortic (Carrel) patch
                                    • Portal vein (PV): End-to-end anastomosis
                                    • Bile duct: Anastomosed end-to-end with recipient duct (70%) or to Roux limb
                                • Cadaver split liver (2 halves to separate recipients)
                                  • Right lobe to adult recipient (IVC, HA, PV, bile duct)
                                  • Left lobe to child recipient (complex anastomoses)
                                • Living donor transplant
                                  • Child recipient: Generally receives lateral segment of donor liver
                                  • Adult recipient: Receives right lobe of donor liver
                                  • Complex biliary and vascular anastomoses

                              IMAGING

                              • Imaging Recommendations

                                • Normal Posttransplantation Findings

                                  • Pretransplantation Evaluation

                                    • Allograft Rejection

                                      • Biliary Complications

                                        • Vascular Complications

                                          • Recurrent Disease Within Allograft

                                            • Extrahepatic Complications

                                              CLINICAL ISSUES

                                              • Natural History & Prognosis

                                                DIAGNOSTIC CHECKLIST

                                                • Image Interpretation Pearls

                                                  Selected References

                                                  1. Horrow MM et al: Complications after liver transplant related to preexisting conditions: diagnosis, treatment, and prevention. Radiographics. 40(3):895-909, 2020
                                                  2. Sannananja B et al: Tricky findings in liver transplant imaging: a review of pitfalls with solutions. Curr Probl Diagn Radiol. 47(3):179-88, 2018
                                                  3. Girometti R et al: Imaging of liver transplantation. Eur J Radiol. 93:295-307, 2017
                                                  4. Baheti AD et al: Surgical techniques and imaging complications of liver transplant. Radiol Clin North Am. 54(2):199-215, 2016
                                                  5. Lai Q et al: Hepatocellular cancer: how to expand safely inclusion criteria for liver transplantation. Curr Opin Organ Transplant. 19(3):229-34, 2014
                                                  6. Song GW et al: Living donor liver transplantation. Curr Opin Organ Transplant. 19(3):217-22, 2014
                                                  7. Liu YI et al: Multidetector computed tomography triphasic evaluation of the liver before transplantation: importance of equilibrium phase washout and morphology for characterizing hypervascular lesions. J Comput Assist Tomogr. 36(2):213-9, 2012
                                                  8. Singh AK et al: Imaging of preoperative liver transplantation in adults: what radiologists should know. Radiographics. 31(4):1017-30, 2011
                                                  9. Miraglia R et al: Interventional radiology procedures in pediatric patients with complications after liver transplantation. Radiographics. 29(2):567-84, 2009
                                                  10. Chen HL et al: Diagnosis and interventional radiological treatment of vascular and biliary complications after liver transplantation in children with biliary atresia. Transplant Proc. 40(8):2534-6, 2008
                                                  11. Ko GY et al: Early posttransplant hepatic venous outflow obstruction: long-term efficacy of primary stent placement. Liver Transpl. 14(10):1505-11, 2008
                                                  12. Caiado AH et al: Complications of liver transplantation: multimodality imaging approach. Radiographics. 27(5):1401-17, 2007
                                                  13. Zhang BL et al: Early sonographic assessment of Budd-Chiari syndrome after orthotopic liver transplantation. J Clin Ultrasound. 35(8):458-61, 2007
                                                  14. Berrocal T et al: Pediatric liver transplantation: a pictorial essay of early and late complications. Radiographics. 26(4):1187-209, 2006
                                                  15. Nishida S et al: Intrahepatic biliary strictures after liver transplantation. J Hepatobiliary Pancreat Surg. 13(6):511-6, 2006
                                                  16. Shin JH et al: Endovascular stent placement for interposed middle hepatic vein graft occlusion after living-donor liver transplantation using right-lobe graft. Liver Transpl. 12(2):269-76, 2006
                                                  17. Thuluvath PJ et al: Biliary complications after liver transplantation: the role of endoscopy. Endoscopy. 37(9):857-63, 2005
                                                  18. Wang SL et al: Treatment of hepatic venous outflow obstruction after piggyback liver transplantation. Radiology. 236(1):352-9, 2005
                                                  19. Boraschi P et al: Complications of orthotopic liver transplantation: imaging findings. Abdom Imaging. 29(2):189-202, 2004
                                                  20. Huang DZ et al: The value of color Doppler ultrasonography in monitoring normal orthotopic liver transplantation and postoperative complications. Hepatobiliary Pancreat Dis Int. 2(1):54-8, 2003
                                                  21. Ko GY et al: Endovascular treatment of hepatic venous outflow obstruction after living-donor liver transplantation. J Vasc Interv Radiol. 13(6):591-9, 2002
                                                  22. Cheng YF et al: Interventional radiologic procedures in liver transplantation. Transpl Int. 14(4):223-9, 2001
                                                  23. Inomata Y et al: Pathogenesis and treatment of bile duct loss after liver transplantation. J Hepatobiliary Pancreat Surg. 8(4):316-22, 2001
                                                  24. Barton P et al: Biliary sludge after liver transplantation: 2. Treatment with interventional techniques versus surgery and/or oral chemolysis. AJR Am J Roentgenol. 164(4):865-9, 1995