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Nagata R, Akamatsu N, Shibata E, Takao H, Ichida A, Mihara Y, Kawaguchi Y, Ishizawa T, Kaneko J, Arita J, Tamura S, Abe O, Hasegawa K. Metallic Stents for Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplantation and their Therapeutic Effects. Transplant Proc 2024; 56:125-134. [PMID: 38177046 DOI: 10.1016/j.transproceed.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/26/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Living-donor liver transplantation (LDLT) is established as a standard therapy for end-stage liver disease; however, vessel reconstruction is more demanding due to the short length and small size of the available structures compared with deceased-donor whole liver transplantation. Interventional radiology (IR) has become the first-line treatment for vascular complications after LDLT. Hepatic venous outflow obstruction (HVOO) is a life-threatening complication after LDLT. The aim of this study of 592 adult-to-adult LDLT cases was to investigate the safety and efficacy of stent implantation for HVOO after LDLT. METHODS Records of patients who developed HVOO requiring any treatment were collected with special reference to the metallic stent implantation. There were 232 left-side grafts and 360 right-side grafts. Sixteen cases developed HVOO after LDLT with an incidence rate of 2.7%, 5 with a left liver graft (2%), and 11 with a right-side graft (3%). The IR was attempted for 14 cases; among those, 8 cases were treated by stent implantation. RESULTS The technical success rate of the initial stent implantation was 100%. The pressure gradient at the stenotic site significantly improved from 12.2 (range, 10.9-20.4 cm H2O) to 3.9 cm H2O (range, 1.4-8.2 cm H2O; P = .03). The volume of the congested graft liver decreased significantly from 1448 (range, 788-2170 mL) to 1265 mL (range, 748-1665 mL; P = .01), and the serum albumin level improved significantly from 3.3 (range, 1.7-3.7 g/dL) to 3.7 g/dL (range, 2.9-4.1 g/dL; P = .02). No procedure-related complication was noted, and the long-term stent patency was 100%. CONCLUSION Metallic stent implantation for stenotic venous anastomosis after LDLT is a safe and effective treatment.
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Affiliation(s)
- Rihito Nagata
- Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Eisuke Shibata
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Hidemasa Takao
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Akihiko Ichida
- Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Yuichiro Mihara
- Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Yoshikuni Kawaguchi
- Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Takeaki Ishizawa
- Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Junichi Kaneko
- Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Junichi Arita
- Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Sumihito Tamura
- Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Department of Surgery, Artificial Organ and Transplantation Division, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan.
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Pull-through technique for hepatic vein angioplasty after liver transplantation. Radiol Case Rep 2023; 18:996-999. [PMID: 36684619 PMCID: PMC9849983 DOI: 10.1016/j.radcr.2022.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/27/2022] [Indexed: 01/07/2023] Open
Abstract
Hepatic venous outflow complication is one of the crucial vascular complications after liver transplantation. We describe successful use of the pull-through technique for hepatic vein angioplasty in a patient with stenosis of the middle and left hepatic veins (MHV and LHV) after living-donor liver transplantation. It was difficult to select the stenotic MHV with a femoral approach. However, the guidewire was unexpectedly inserted into a small collateral vein and selective angiography showed the MHV through the collaterals. Because the guidewire proceeded to the MHV via the collateral and finally into the inferior vena cava, we advanced a catheter from the inferior vena cava to the MHV using the pull-through technique and performed balloon angioplasty.
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Gonzalez A, Cooper E, Herren J, Lipnik AJ, Xie KL. Diagnostic and Interventional Radiology in the Management of Post-Liver Transplant Vascular Complications. Semin Intervent Radiol 2022; 39:537-544. [PMID: 36561931 PMCID: PMC9767772 DOI: 10.1055/s-0042-1758113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ana Gonzalez
- University of Illinois College of Medicine, Chicago, Illinois
| | - Eric Cooper
- University of Illinois College of Medicine, Chicago, Illinois
| | - Josi Herren
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Andrew J. Lipnik
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Karen L. Xie
- Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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Güven F, Karaca L, Ogul H, Sade R, Öztürk G, Kantarci M. The Value of Superb Microvascular Imaging in Detecting Hepatic Artery Occlusion in Liver Transplantation. Ultrasound Q 2019; 35:325-329. [DOI: 10.1097/ruq.0000000000000416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lu KT, Cheng YF, Chen TY, Tsang LC, Ou HY, Yu CY, Hsu HW, Lim WX, Tong YS, Huang TL. Efficiency of Transluminal Angioplasty of Hepatic Venous Outflow Obstruction in Pediatric Liver Transplantation. Transplant Proc 2018; 50:2715-2717. [DOI: 10.1016/j.transproceed.2018.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 01/10/2023]
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Jeng KS, Huang CC, Tsai HY, Hsu JC, Lin CK, Chen KH. Novel use of percutaneous thrombosuction to rescue the early thrombosis of the conduit vein graft after living donor liver transplantation. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:204-209. [PMID: 30148240 PMCID: PMC6105764 DOI: 10.1016/j.jvscit.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/20/2018] [Indexed: 11/20/2022]
Abstract
A 54-year-old woman with liver cirrhosis and hepatocellular carcinoma received a living donor liver transplant. Thrombosis of the segmental hepatic vein occurred on postoperative day 7. We undertook percutaneous catheter thrombosuction under local anesthesia to extract the thrombus successfully without re-exploration. Thrombosuction has been used for thrombosis of the cardiovascular system, limbs, and brain. We first used it in hepatic venous thrombus after liver transplantation. This procedure is simple, less invasive, feasible, safe, repeatable, and effective.
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Affiliation(s)
- Kuo-Shyang Jeng
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Correspondence: Kuo-Shyang Jeng, MD, FACS, Department of Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S Rd, Banciao Dist, New Taipei City 220, Taiwan, ROC
| | - Chun-Chieh Huang
- Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hao-Yuan Tsai
- Division of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jung-Cheng Hsu
- Division of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Kuan Lin
- Division of Hepatology and Gastroenterology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuo-Hsin Chen
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Li JW, Lu Q, Luo Y. Hepatic Venous Outflow Stenosis After Auxiliary Left Hemiliver Transplantation Diagnosed by Ultrasonic Shear Wave Elastography Combined With Doppler Ultrasonography. Ultrasound Q 2017; 33:289-292. [PMID: 29190228 PMCID: PMC5704733 DOI: 10.1097/ruq.0000000000000306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/03/2017] [Indexed: 02/05/2023]
Abstract
Hepatic vein stenosis after liver transplantation is a relatively rare complication that could even result in graft loss. However, it is difficult to arrive at a definite diagnosis at the early stage of postoperation, and there are few researches on ultrasonic shear wave elastography in the diagnosis of hepatic vein stenosis. We report the case of an 11-year-old male patient with cirrhosis due to hepatolenticular degeneration who received an auxiliary left hemiliver graft from his uncle. Massive ascites developed in 4 days after the operation. Stenosis was suspected at the site of anastomosis by Doppler ultrasonography when elevating the velocity of the left hepatic vein. Meanwhile, increased stiffness of the graft was revealed by ultrasonic shear wave elastography. The stenosis was confirmed by subsequent digital subtraction angiography. Ascites decreased gradually after the stent implantation. Our case indicates that ultrasonic shear wave elastography combined with Doppler ultrasonography is a promising method for noninvasive diagnosis of hepatic venous outflow stenosis following liver transplantation.
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Affiliation(s)
- Jia-Wu Li
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Patel R, Mahaveer J, Tahir N, Rajwal S, McClean P, Patel JV. Outcomes of Percutaneous Portal Vein Intervention in a Single UK Paediatric Liver Transplantation Programme. Cardiovasc Intervent Radiol 2017; 41:96-103. [PMID: 28913651 PMCID: PMC5735201 DOI: 10.1007/s00270-017-1792-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/01/2017] [Indexed: 01/10/2023]
Abstract
Introduction Percutaneous transluminal angioplasty (PTA), with or without stent placement, has become the treatment of choice for portal vein complications (PVC) following liver transplantation. We aimed to assess long-term outcomes of intervention in paediatric transplant recipients, in a single institution. Materials and Methods 227 children received 255 transplants between November 2000 and September 2016. 30 patients developed PVC of whom 21 had percutaneous intervention. Retrospective clinical and procedural outcome data on these 21 patients were collected. Results 21 patients, with median age 1.7 years (range 0.4–16.2), underwent 42 procedures with PTA with or without stenting. 36 procedures were for PV stenosis and 6 for PV thrombosis. Treatment was with primary PTA, with stenting reserved for suboptimal PTA result or restenosis within 3 months. 28 procedures were performed with PTA and 13 with stenting. Technical success (>50% reduction in mean pressure gradient, absolute pressure gradient ≤4 mmHg or venographic stenosis <30%) was achieved in 41 procedures. Failure to recanalise a thrombosed PV occurred in 1 procedure. There were no major procedural complications. Patients were followed-up with serial Doppler ultrasound surveillance. Kaplan–Meier estimated median primary patency was 9.9 months, with primary-assisted patency of 95% after median follow-up of 45.5 months (range 11.1–171.6). Conclusion With regular surveillance, excellent patency rates can be achieved following percutaneous intervention for PVC post-paediatric liver transplantation.
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Affiliation(s)
- Ravi Patel
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jeevan Mahaveer
- Departmentt of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nasim Tahir
- Departmentt of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sanjay Rajwal
- Department of Paediatric Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Patricia McClean
- Department of Paediatric Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jai V Patel
- Departmentt of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Girometti R, Pancot M, Como G, Zuiani C. Imaging of liver transplantation. Eur J Radiol 2017; 93:295-307. [PMID: 28545872 DOI: 10.1016/j.ejrad.2017.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 12/12/2022]
Abstract
Liver transplantation (LT) is the treatment of choice for end-stage chronic liver disease, fulminant liver failure and early stage hepatocellular carcinoma. As discussed in this review, state-of-the-art imaging modalities including ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) play a pivotal role in the selection of patients and donors, as well as in early detection of those complications at risk of impairing graft function and/or survival. We also illustrate main imaging findings related to the wide spectrum of clinical problems raised by LT.
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Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine-Azienda Ospedaliero-Universitaria Santa Maria della Misericordia-Via Colugna, 50-33100-Udine, Italy.
| | - Martina Pancot
- Institute of Radiology, Department of Medicine, University of Udine-Azienda Ospedaliero-Universitaria Santa Maria della Misericordia-Via Colugna, 50-33100-Udine, Italy.
| | - Giuseppe Como
- Institute of Radiology, Department of Medicine, University of Udine-Azienda Ospedaliero-Universitaria Santa Maria della Misericordia-Via Colugna, 50-33100-Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine-Azienda Ospedaliero-Universitaria Santa Maria della Misericordia-Via Colugna, 50-33100-Udine, Italy.
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10
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Total IVC Occlusion as an Unusual Cause of Acute Renal Failure After Orthotopic Liver Transplantation. Int Surg 2017. [DOI: 10.9738/intsurg-d-14-00308.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Renal dysfunction before and after orthotopic liver transplantation (OLT) has significant implications for morbidity and mortality of these patients. We describe the management of a 72-year-old male patient with history of alcoholic liver cirrhosis (MELD 38) undergoing OLT. The patient presented with declining renal function prior to OLT (baseline GFR <25 mL/min) due to diuretic therapy for refractory ascites, hypovolemia postgastrointestinal bleed, and possible hepatorenal syndrome. The intraoperative management was complicated by preexisting anemia (hematocrit, 22%), unusual RBC antibody (anti-JKa) and significant surgical blood loss. To achieve surgical hemostasis, temporary clamping of the inferior vena cava (IVC) caudal to the transplanted liver was necessary. Postoperatively, the patient remained anuric despite appropriate fluid resuscitation. Renal replacement therapy was initiated to balance volume and acid-base status. A venogram on postoperative day (POD) 5 indicated a complete IVC occlusion and caval thrombectomy was performed on POD 6. After restoration of venous renal drainage, renal function improved and renal replacement therapy was weaned. Renal function indicators normalized in 8 weeks, and remained unimpaired up to 3 months post-OLT. Unintended complete obstruction of the suprarenal IVC may occur during OLT to control surgical bleeding, and should be considered as a cause for acute renal failure after liver transplant. Despite the preexisting renal dysfunction, renal function quickly improved after restoration of blood flow drainage and normalized in less than 8 weeks post obstruction.
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11
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Bass LM, Kim S, Superina R, Mohammad S. Jejunal varices diagnosed by capsule endoscopy in patients with post-liver transplant portal hypertension. Pediatr Transplant 2017; 21. [PMID: 27762481 DOI: 10.1111/petr.12818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 12/11/2022]
Abstract
Portal hypertension secondary to portal vein obstruction following liver transplant occurs in 5%-10% of children. Jejunal varices are uncommon in this group. We present a case series of children with significant GI blood loss, negative upper endoscopy, and jejunal varices detected by CE. Case series of patients who had CE for chronic GI blood loss following liver transplantation. Three patients who had their initial transplants at a median age of 7 months were identified at our institution presenting at a median age of 8 years (range 7-16 years) with a median Hgb of 2.8 g/dL (range 1.8-6.8 g/dL). Upper endoscopy was negative for significant esophageal varices, gastric varices, and bleeding portal gastropathy in all three children. All three patients had significant jejunal varices noted on CE in mid-jejunum. Jejunal varices were described as large prominent bluish vessels underneath visualized mucosa, one with evidence of recent bleeding. The results led to venoplasty of the portal vein in two patients and a decompressive shunt in one patient with resolution of GI bleed and anemia. CE is useful to diagnose intestinal varices in children with portal hypertension and GI bleeding following liver transplant.
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Affiliation(s)
- Lee M Bass
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stanley Kim
- Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Riccardo Superina
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Saeed Mohammad
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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Prognostic significance of hepatic arterial collaterals in liver transplant recipients with biliary strictures. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 12/20/2022]
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Chu HH, Yi NJ, Kim HC, Lee KW, Suh KS, Jae HJ, Chung JW. Longterm outcomes of stent placement for hepatic venous outflow obstruction in adult liver transplantation recipients. Liver Transpl 2016; 22:1554-1561. [PMID: 27516340 DOI: 10.1002/lt.24598] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/23/2016] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to evaluate the longterm outcomes of stent placement for a hepatic venous outflow obstruction in adult liver transplantation recipients. From June 2002 to March 2014, 23 patients were confirmed to have a hepatic venous outflow obstruction after liver transplantation (18 of 789 living donors [2.3%] and 5 of 449 deceased donors [1.1%]) at our institute. Among these patients, stent placement was needed for 16 stenotic lesions in 15 patients (12 males, 3 females; mean age, 51.7 years). The parameters that were documented retrospectively were technical success, clinical success, complications, recurrence, and the patency of the stent. The technical success rate was 100% (16/16). Clinical success was achieved in 11 of the 15 patients (73.3%). A major complication occurred in only 1 patient-a hepatic vein laceration during the navigation of the occluded segment. The median follow-up period was 33.5 months (range, 0.5-129.3 months), and the overall 1-, 3-, and 5-year primary patency rates of the stent were all 93.8%. One case of occlusion of the stent without clinical signs and symptoms was observed 5 days after the initial procedure. In this patient, the stent was recanalized by balloon angioplasty and showed patent lumen for 48 months of the subsequent follow-up period. In conclusion, stent placement is a safe and effective treatment modality with favorable longterm outcomes to treat hepatic venous outflow obstruction in adult liver transplantation recipients. Liver Transplantation 22 1554-1561 2016 AASLD.
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Affiliation(s)
- Hee Ho Chu
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Teegen EM, Denecke T, Eisele R, Lojewski C, Neuhaus P, Chopra SS. Clinical application of modern ultrasound techniques after liver transplantation. Acta Radiol 2016; 57:1161-70. [PMID: 26924835 DOI: 10.1177/0284185116633910] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 01/21/2016] [Indexed: 12/14/2022]
Abstract
Liver transplantation has been established as a first-line therapy for a number of indications. Conventional ultrasound and contrast-enhanced ultrasound (CEUS) are methods of choice during the postoperative period as a safe and fast tool to detect potential complications and to enable early intervention if necessary. CEUS increases diagnostic quality and is an appropriate procedure for the examination of vessels and possibly bile ducts. This article presents the state of the art of ultrasound application during the early period after liver transplantation. It addresses common vascular complications and describes the identification of postoperative abnormal findings using ultrasound and CEUS.
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15
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Abdelaziz O, Attia H. Doppler ultrasonography in living donor liver transplantation recipients: Intra- and post-operative vascular complications. World J Gastroenterol 2016; 22:6145-72. [PMID: 27468207 PMCID: PMC4945976 DOI: 10.3748/wjg.v22.i27.6145] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/18/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Living-donor liver transplantation has provided a solution to the severe lack of cadaver grafts for the replacement of liver afflicted with end-stage cirrhosis, fulminant disease, or inborn errors of metabolism. Vascular complications remain the most serious complications and a common cause for graft failure after hepatic transplantation. Doppler ultrasound remains the primary radiological imaging modality for the diagnosis of such complications. This article presents a brief review of intra- and post-operative living donor liver transplantation anatomy and a synopsis of the role of ultrasonography and color Doppler in evaluating the graft vascular haemodynamics both during surgery and post-operatively in accurately defining the early vascular complications. Intra-operative ultrasonography of the liver graft provides the surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach and corrections of surgical complications during the procedure of vascular anastomoses. The relevant intra-operative anatomy and the spectrum of normal and abnormal findings are described. Ultrasonography and color Doppler also provides the clinicians and surgeons early post-operative potential developmental complications that may occur during hospital stay. Early detection and thus early problem solving can make the difference between graft survival and failure.
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Di Martino M, Rossi M, Mennini G, Melandro F, Anzidei M, De Vizio S, Koryukova K, Catalano C. Imaging follow-up after liver transplantation. Br J Radiol 2016; 89:20151025. [PMID: 27188846 DOI: 10.1259/bjr.20151025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Liver transplantation (LT) represents the best treatment for end-stage chronic liver disease, acute liver failure and early stages of hepatocellular carcinoma. Radiologists should be aware of surgical techniques to distinguish a normal appearance from pathological findings. Imaging modalities, such as ultrasound, CT and MR, provide for rapid and reliable detection of vascular and biliary complications after LT. The role of imaging in the evaluation of rejection and primary graft dysfunction is less defined. This article illustrates the main surgical anastomoses during LT, the normal appearance and complications of the liver parenchyma and vascular and biliary structures.
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Affiliation(s)
- Michele Di Martino
- 1 Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Rome, Italy
| | - Massimo Rossi
- 2 Department of General Surgery, Division of Organ Transplantation, University of Rome "Sapienza", Rome, Italy
| | - Gianluca Mennini
- 2 Department of General Surgery, Division of Organ Transplantation, University of Rome "Sapienza", Rome, Italy
| | - Fabio Melandro
- 2 Department of General Surgery, Division of Organ Transplantation, University of Rome "Sapienza", Rome, Italy
| | - Michele Anzidei
- 1 Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Rome, Italy
| | - Silvia De Vizio
- 1 Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Rome, Italy
| | - Kameliya Koryukova
- 1 Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Rome, Italy
| | - Carlo Catalano
- 1 Department of Radiological Sciences, Oncology and Anatomical Pathology, University of Rome "Sapienza", Rome, Italy
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17
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Ma L, Lu Q, Luo Y. Vascular complications after adult living donor liver transplantation: Evaluation with ultrasonography. World J Gastroenterol 2016; 22:1617-1626. [PMID: 26819527 PMCID: PMC4721993 DOI: 10.3748/wjg.v22.i4.1617] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/12/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
Living donor liver transplantation (LDLT) has been widely used to treat end-stage liver disease with improvement in surgical technology and the application of new immunosuppressants. Vascular complications after liver transplantation remain a major threat to the survival of recipients. LDLT recipients are more likely to develop vascular complications because of their complex vascular reconstruction and the slender vessels. Early diagnosis and treatment are critical for the survival of graft and recipients. As a non-invasive, cost-effective and non-radioactive method with bedside availability, conventional gray-scale and Doppler ultrasonography play important roles in identifying vascular complications in the early postoperative period and during the follow-up. Recently, with the detailed vascular tracing and perfusion visualization, contrast-enhanced ultrasound (CEUS) has significantly improved the diagnosis of postoperative vascular complications. This review focuses on the role of conventional gray-scale ultrasound, Doppler ultrasound and CEUS for early diagnosis of vascular complications after adult LDLT.
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Fujimori M, Yamakado K, Takaki H, Nakatsuka A, Uraki J, Yamanaka T, Hasegawa T, Sugino Y, Nakajima K, Matsushita N, Mizuno S, Sakuma H, Isaji S. Long-Term Results of Stent Placement in Patients with Outflow Block After Living-Donor-Liver Transplantation. Cardiovasc Intervent Radiol 2015; 39:566-74. [DOI: 10.1007/s00270-015-1210-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/12/2015] [Indexed: 12/14/2022]
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Frongillo F, Lirosi MC, Nure E, Inchingolo R, Bianco G, Silvestrini N, Avolio AW, De Gaetano AM, Cina A, Di Stasi C, Sganga G, Agnes S. Diagnosis and Management of Hepatic Artery Complications After Liver Transplantation. Transplant Proc 2015; 47:2150-5. [PMID: 26361665 DOI: 10.1016/j.transproceed.2014.11.068] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/19/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND We assessed the usefulness of color Doppler imaging in diagnosis and monitoring hepatic artery complications after liver transplantation. METHODS Subjects were 421 liver transplant recipients who underwent serial ultrasound (US) color Doppler evaluations of the hepatic arteries after surgery. RESULTS We saw 4 hepatic arterial complications after liver transplantation (13 thrombosis, 29 stenosis, 2 kinking, 2 pseudo-aneurysm, and 2 pseudo-aneurysm rupture). All subjects underwent US color Doppler examination periodically after surgery. In 6 cases of early thrombosis, hepatic arterial obstruction was diagnosed with absence of Doppler signals; in the other 7 cases (late hepatic artery thrombosis), thrombosis was suspected for the presence of intra-parenchymal "tardus-parvus" waveforms. In all of the cases, computed tomography angiography showed obstruction of the main arterial trunk and the development of compensatory collateral circles (late hepatic artery thrombosis). In 10 of the 29 cases of stenosis, Doppler ultrasonography examination revealed stenotic tract and intra-hepatic tardus-parvus waveforms; in 17 stenosis cases, the site of stenosis could not be identified, but intra-parenchymal tardus-parvus waveforms were recorded. In 2 patients, hepatic artery stenosis occurred with ischemic complications. CONCLUSIONS The use of US color Doppler examination allows the early diagnosis of hepatic arterial complications after liver transplantation. Tardus-parvus waveforms indicated severe impairment of hepatic arterial perfusion from either thrombosis or severe stenosis. The presence of these indirect signs enhanced the accuracy of color Doppler diagnosis, and detection should prompt therapy.
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Affiliation(s)
- F Frongillo
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy
| | - M C Lirosi
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy.
| | - E Nure
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy
| | - R Inchingolo
- Department of Bio-Sciences and Radiological Imaging, Catholic University of the Sacred Heart, Rome, Italy, and Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy
| | - G Bianco
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy
| | - N Silvestrini
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy
| | - A W Avolio
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy
| | - A M De Gaetano
- Department of Bio-Sciences and Radiological Imaging, Catholic University of the Sacred Heart, Rome, Italy, and Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy
| | - A Cina
- Department of Bio-Sciences and Radiological Imaging, Catholic University of the Sacred Heart, Rome, Italy, and Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy
| | - C Di Stasi
- Department of Bio-Sciences and Radiological Imaging, Catholic University of the Sacred Heart, Rome, Italy, and Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy
| | - G Sganga
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy
| | - S Agnes
- Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Policlinico "A. Gemelli," Largo A. Gemelli, Rome, Italy
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Kogut MJ, Shin DS, Padia SA, Johnson GE, Hippe DS, Valji K. Intra-Arterial Thrombolysis for Hepatic Artery Thrombosis following Liver Transplantation. J Vasc Interv Radiol 2015; 26:1317-22. [PMID: 26190188 DOI: 10.1016/j.jvir.2015.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Hepatic artery thrombosis (HAT) is a major cause of morbidity and death following liver transplantation. The purpose of this study was to evaluate the safety and efficacy of intra-arterial thrombolysis (IAT) in liver transplant recipients with HAT. MATERIALS AND METHODS Adult liver transplant recipients who underwent attempted IAT for HAT were identified. This included patients with early and late HAT (occurring less than or greater than 30 d after transplantation). Records were reviewed to determine the rates of technical success, complications, surgical revascularization, repeat liver transplantation, and ischemic cholangiopathy. RESULTS Twenty-six patients underwent attempted thrombolysis, 13 of whom had early HAT. IAT was successfully initiated in 23 patients (88%), with a median IAT duration of 28 hours (range, 12-90 h). Recanalization was achieved in 12 patients (46%). Major complications were observed in 11 patients (42%). The early HAT group showed a trend toward increased major bleeding compared with the late HAT group (50% vs 9%; P = .07). Among 12 patients who had technically successful thrombolysis, five (42%) required surgical revascularization or repeat transplantation within 2 months. At 6 months after thrombolysis, 45% with unsuccessful recanalization avoided surgery or development of ischemic cholangiopathy, similar to the proportion in those who had successful recanalization (42%; P = .88). CONCLUSIONS Posttransplantation hepatic artery thrombolysis yields suboptimal results with a high complication rate, especially in early HAT. Even with successful restoration of flow, clinical outcomes are poor. Although thrombolysis may still be considered in view of the limited treatment options for HAT, awareness of potential complications and suboptimal success rate is essential.
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Affiliation(s)
- Matthew J Kogut
- Interventional Radiology Section, University of Washington, 1959 NE Pacific St., Seattle, WA 98195; Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195.
| | - David S Shin
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195
| | - Siddharth A Padia
- Interventional Radiology Section, University of Washington, 1959 NE Pacific St., Seattle, WA 98195; Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195
| | - Guy E Johnson
- Interventional Radiology Section, University of Washington, 1959 NE Pacific St., Seattle, WA 98195; Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195
| | - Daniel S Hippe
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195
| | - Karim Valji
- Interventional Radiology Section, University of Washington, 1959 NE Pacific St., Seattle, WA 98195; Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA 98195
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21
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Lee H, Lim CW, Yoo SH, Koo CH, Kwon WI, Suh KS, Ryu HG. The effect of Doppler ultrasound on early vascular interventions and clinical outcomes after liver transplantation. World J Surg 2015; 38:3202-9. [PMID: 25123179 DOI: 10.1007/s00268-014-2721-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND During the immediate postoperative period after liver transplantation (LT), postoperative bleeding and vascular complications (stenosis, thrombosis) are the two most common complications that require therapeutic decisions. Doppler ultrasound (DUS) is the established method for screening vascular patency after LT during the immediate postoperative period. The objective of our study was to evaluate the impact of DUS performed on postoperative days (POD) 1 and 2 on early vascular interventions. METHODS We studied 200 patients who had undergone living donor or deceased donor liver transplantation between January 2011 and March 2012. Postoperative liver DUS findings of up to POD 14, including patency of hepatic artery, portal vein, and hepatic vein, were retrieved. Patients with normal DUS findings on POD 1 and POD 2 were classified as the normal early DUS group. Patients with abnormal DUS findings at POD1 or POD2 were classified as the abnormal early DUS group. Frequency of vascular interventions was compared between the two groups. Risk factors that predict vascular interventions also were assessed. RESULTS On POD 1 and 2, 81.5 % (163/200) had normal DUS findings and management was not altered by subsequent DUS findings. Two patients in the normal group were found to have hepatic artery dissection and hepatic vein thrombosis on routine CT on POD 7 and received vascular intervention. DUS results in the two patients were normal until POD 6, but DUS performed after the CT on POD 7 were consistent with the CT findings. Of the 37 recipients who showed abnormal DUS findings on POD 1 or 2, the DUS findings were normalized or unchanged thereafter in 33 patients and no vascular interventions were performed. Two patients underwent hepatic artery thrombectomy on POD 2, one patient required a portal vein thrombectomy on POD 1, and one patient died on POD 3 due to bleeding. The overall incidence of vascular complication requiring vascular interventions was 2.5 %. Logistic regression identified abnormal DUS findings on POD 1 or 2 as an independent risk factor of vascular complications requiring intervention. CONCLUSIONS In LT recipients who demonstrate normal DUS findings in the first 2 postoperative days, additional DUS screening may have value only when clinically indicated.
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Affiliation(s)
- Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, Korea,
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Copelan A, George D, Kapoor B, Nghiem HV, Lorenz JM, Erly B, Wang W. Iatrogenic-related transplant injuries: the role of the interventional radiologist. Semin Intervent Radiol 2015; 32:133-55. [PMID: 26038621 DOI: 10.1055/s-0035-1549842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As advances in surgical techniques and postoperative care continue to improve outcomes, the use of solid organ transplants as a treatment for end-stage organ disease is increasing. With the growing population of transplant patients, there is an increasing need for radiologic diagnosis and minimally invasive procedures for the management of posttransplant complications. Typical complications may be vascular or nonvascular. Vascular complications include arterial stenosis, graft thrombosis, and development of fistulae. Common nonvascular complications consist of leaks, abscess formation, and stricture development. The use of interventional radiology in the management of these problems has led to better graft survival and lower patient morbidity and mortality. An understanding of surgical techniques, postoperative anatomy, radiologic findings, and management options for complications is critical for proficient management of complex transplant cases. This article reviews these factors for kidney, liver, pancreas, islet cell, lung, and small bowel transplants.
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Affiliation(s)
- Alexander Copelan
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Daniel George
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Baljendra Kapoor
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hahn Vu Nghiem
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Jonathan M Lorenz
- Section of Interventional Radiology, The University of Chicago, Chicago, Illinois
| | - Brian Erly
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio ; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Weiping Wang
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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Abstract
Due to progressive advances in surgical techniques, immunosuppressive therapies, and supportive care, outcomes from both solid organ transplantation and hematopoietic stem cell transplantation continue to improve. Thrombosis remains a challenging management issue in this context, with implications for both graft survival and long-term quality of life. Unfortunately, there remains a general paucity of pediatric-specific data regarding thrombosis incidence, risk stratification, and the safety or efficacy of preventative strategies with which to guide treatment algorithms. This review summarizes the available evidence and rationale underlying the spectrum of current practices aimed at preventing thrombosis in the transplant recipient, with a particular focus on risk factors, pathophysiology, and described antithrombotic regimens.
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Affiliation(s)
- J D Robertson
- Haematology Service, Division of Medicine, Lady Cilento Children's Hospital, Brisbane, Qld, Australia
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Wang Q, Gaofeng S, Xueli F, Lijia W, Runze W. Comparative study of hepatic venography using non-linear-blending images, monochromatic images and low-voltage images of dual-energy CT. Br J Radiol 2014; 87:20140220. [PMID: 25051976 DOI: 10.1259/bjr.20140220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To investigate the use of non-linear-blending and monochromatic dual-energy CT (DECT) images to improve the image quality of hepatic venography. METHODS 82 patients undergoing abdominal DECT in the portal venous phase were enrolled. For each patient, 31 data sets of monochromatic images and 7 data sets of non-linear-blending images were generated. The data sets of the non-linear-blending and monochromatic images with the best contrast-to-noise ratios (CNRs) for hepatic veins were selected and compared with the images obtained at 80 kVp and a simulated 120 kVp. The subjective image quality of the hepatic veins was evaluated using a four-point scale. The image quality of the hepatic veins was analysed using signal-to-noise ratio (SNR) and CNR values. RESULTS The optimal CNR between hepatic veins and the liver was obtained with the non-linear-blending images. Compared with the other three groups, there were significant differences in the maximum CNR, the SNR, the subjective ratings and the minimum background noise (p < 0.001). A comparison of the monochromatic and 80-kVp images revealed that the CNR and subjective ratings were both improved (p < 0.001). There was no significant difference in the CNR or subjective ratings between the simulated 120-kVp group and the control group (p = 0.090 and 0.053, respectively). CONCLUSION The non-linear-blending technique for acquiring DECT provided the best image quality for hepatic venography. ADVANCES IN KNOWLEDGE DECT can enhance the contrast of hepatic veins and the liver, potentially allowing the wider use of low-dose contrast agents for CT examination of the liver.
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Affiliation(s)
- Q Wang
- 1 Department of Radiology, the Fourth Clinical Hospital of Hebei Medical University, Shijiazhuang, China
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25
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Itri JN, Heller MT, Tublin ME. Hepatic transplantation: postoperative complications. ACTA ACUST UNITED AC 2014; 38:1300-33. [PMID: 23644931 DOI: 10.1007/s00261-013-0002-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Advances in surgical techniques and immunosuppression have made orthotopic liver transplantation a first-line treatment for many patients with end-stage liver disease. The early detection and treatment of postoperative complications has contributed significantly to improved graft and patient survival with imaging playing a critical role in detection. Complications that can lead to graft failure or patient mortality include vascular abnormalities, biliary abnormalities, allograft rejection, and recurrent or post-transplant malignancy. Vascular abnormalities include stenosis and thrombosis of the hepatic artery, portal vein, and inferior vena cava, as well as hepatic artery pseudoaneurysm, arteriovenous fistula, and celiac stenosis. Biliary abnormalities include strictures, bile leak, obstruction, recurrent disease, and infection. While imaging is not used to diagnose allograft rejection, it plays an important role in identifying complications that can mimic rejection. Ultrasound is routinely performed as the initial imaging modality for the detection and follow-up of both early and delayed complications. Cholangiography and magnetic resonance cholangiopancreatography are used to characterize biliary complications and computed tomography is used to confirm abnormal findings on ultrasound or for the evaluation of postoperative collections. The purpose of this article is to describe and illustrate the imaging appearances and management of complications associated with liver transplantation.
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Affiliation(s)
- Jason N Itri
- University of Pittsburgh Medical Center, 200 Lothrop Street Presby South Tower, Suite 4896, Pittsburgh, PA, USA,
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26
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Girometti R, Como G, Bazzocchi M, Zuiani C. Post-operative imaging in liver transplantation: State-of-the-art and future perspectives. World J Gastroenterol 2014; 20:6180-6200. [PMID: 24876739 PMCID: PMC4033456 DOI: 10.3748/wjg.v20.i20.6180] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Orthotopic liver transplantation (OLT) represents a major treatment for end-stage chronic liver disease, as well as selected cases of hepatocellular carcinoma and acute liver failure. The ever-increasing development of imaging modalities significantly contributed, over the last decades, to the management of recipients both in the pre-operative and post-operative period, thus impacting on graft and patients survival. When properly used, imaging modalities such as ultrasound, multidetector computed tomography, magnetic resonance imaging (MRI) and procedures of direct cholangiography are capable to provide rapid and reliable recognition and treatment of vascular and biliary complications occurring after OLT. Less defined is the role for imaging in assessing primary graft dysfunction (including rejection) or chronic allograft disease after OLT, e.g., hepatitis C virus (HCV) recurrence. This paper: (1) describes specific characteristic of the above imaging modalities and the rationale for their use in clinical practice; (2) illustrates main imaging findings related to post-OLT complications in adult patients; and (3) reviews future perspectives emerging in the surveillance of recipients with HCV recurrence, with special emphasis on MRI.
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27
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Han H, Liu R, Wang WP, Ding H, Wen JX, Lin XY. Postoperative haemodynamic changes in transplanted liver: Long-term follow-up with ultrasonography. J Int Med Res 2014; 42:849-56. [PMID: 24651994 DOI: 10.1177/0300060514521153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/18/2013] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate haemodynamic changes in the transplanted liver without postoperative complications. METHODS Colour Doppler ultrasound was used to monitor recipients of liver transplants who had no postoperative complications. The haemodynamic data for the hepatic vasculature were compared at different time-points during the first 4 years after liver transplantation. RESULTS A total of 144 liver transplant patients were enrolled in the study. Portal vein flow velocity decreased significantly from 72.1 ± 30.3 cm/s at 1 day to 44.2 ± 20.1 cm/s at 1 month after liver transplantation. Hepatic artery flow velocity was 61.4 ± 33.2 cm/s at day 1; it then decreased slowly but significantly to 48.3 ± 20.4 cm/s at 3 years after transplantation. There were 81 (56.3%) patients with high hepatic artery resistance index (HARI) (>0.80) and 19 (13.2%) with low HARI (<0.50) measured at least once during the 4-year follow-up examination. CONCLUSIONS Decreased portal vein flow velocity was the typical change observed during the first month after liver transplantation. Abnormal haemodynamic Doppler results should be interpreted with caution because they may not be clinically significant and may improve spontaneously.
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Affiliation(s)
- Hong Han
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rong Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie-Xian Wen
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xi-Yuan Lin
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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28
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Yabuta M, Shibata T, Shibata T, Shinozuka K, Isoda H, Okamoto S, Uemoto S, Togashi K. Long-term outcome of percutaneous interventions for hepatic venous outflow obstruction after pediatric living donor liver transplantation: experience from a single institute. J Vasc Interv Radiol 2013; 24:1673-81. [PMID: 24008112 DOI: 10.1016/j.jvir.2013.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/05/2013] [Accepted: 07/08/2013] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate retrospectively the long-term outcome of percutaneous interventions for hepatic venous outflow obstruction (HVOO) occurring after pediatric living donor liver transplantation (LDLT). MATERIALS AND METHODS Between October 1997 and December 2012, 48 patients (24 boys, 24 girls; median age, 6 y) who had undergone LDLT were confirmed to have HVOO using percutaneous hepatic venography and manometry. All patients underwent percutaneous interventions, including balloon angioplasty with or without stent placement. Technical success, clinical success, patency rates, stent placement, and major complications were evaluated. RESULTS Technical success was achieved in 92 of 93 sessions (99.0%) and in 47 of 48 patients (97.9%), and clinical success was achieved in 41 of 48 patients (85.4%). During the follow-up period (range, 1-182 mo; median, 51.5 mo), 28 patients were treated with a single session of balloon angioplasty, and 20 patients who developed recurrent stenosis were treated with repeated percutaneous interventions. The rates of primary and primary-assisted patency at 1, 3, 5, and 10 years after balloon angioplasty were 64%, 57%, 57%, and 52% (primary patency) and 98%, 95%, 95%, and 95% (primary-assisted patency). Of six patients with stent placement, four had no recurrent HVOO after the stent placement, but two developed recurrent stenosis. The stent migrated to the right atrium in one patient. CONCLUSIONS Percutaneous interventions were effective treatments for HVOO after LDLT.
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Affiliation(s)
- Minoru Yabuta
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine,54-Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Frongillo F, Grossi U, Lirosi MC, Nure E, Sganga G, Avolio AW, Inchingolo R, Di Stasi C, Rinaldi P, Agnes S. Incidence, management, and results of hepatic artery stenosis after liver transplantation in the era of donor to recipient match. Transplant Proc 2013; 45:2722-5. [PMID: 24034032 DOI: 10.1016/j.transproceed.2013.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Hepatic artery stenosis (HAS) is an important complication after liver transplantation. However, studies are not conclusive in terms of definition, incidence, best treatment, and timing of intervention. The aim of this study was to evaluate the incidence of SSHA that occurred in a single center over the past 12 years, pointing out diagnostic and therapeutic strategies. METHODS The incidence of HAS was reviewed in 258 liver transplant recipients between January 1999 and December 2011. All patients underwent Doppler ultrasound (DUS) at fixed times. Multidetector computed tomographic angiography (MDCTA) was performed to confirm the DUS findings. RESULTS HAS occurred in 23 cases (9.3%). In all cases diagnosis was performed by DUS resulting in a sensitivity of 100% and a specificity of 99.6%. Based on DUS and MDCTA data integration, in 10 cases we adopted the "wait and see" strategy, whereas 13 patients underwent interventional radiology techniques. CONCLUSION DUS monitoring is efficacious in the diagnosis of HAS after liver transplantation. Interventional radiology procedures are safe and efficacious.
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Affiliation(s)
- F Frongillo
- Division of General Surgery and Organ's Transplantation Service, Department of Surgical Sciences, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli, 8 - 00168 Rome, Italy; Department of Bioimaging and Radiological Sciences, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli, 8 - 00168 Rome, Italy.
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Soin AS. Smoothing the path: reducing biliary complications, addressing small-for-size syndrome, and making other adaptations to decrease the risk for living donor liver transplant recipients. Liver Transpl 2012; 18 Suppl 2:S20-4. [PMID: 22927168 DOI: 10.1002/lt.23541] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
1. Over the course of the past 2 decades, living donor liver transplantation (LDLT) has become increasingly successful because many of the technical issues plaguing it have been resolved. 2. Although donor safety remains a concern, most challenges related to the recipient's surgery are now better understood, and they appear surmountable. 3. The following concepts need to be addressed for optimal recipient outcomes to be achieved: a. Reduction of the risk of small-for-size syndrome in LDLT (ie, the management of 4 factors: the recipient status, the portal pressure and inflow, the venous outflow, and the graft-to-recipient weight ratio/graft quality). b. Reduction of the risk of surgical complications (biliary complications, reconstitution of the middle hepatic vein outflow in the right lobe graft, and safe hepatic artery and portal vein reconstruction). c. Other adaptations for improving recipient outcomes (adaptations related to LDLT and adaptations common to deceased donor liver transplantation and LDLT).
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Affiliation(s)
- Arvinder S Soin
- Medanta Institute of Liver Surgery and Transplantation, Medicity, Gurgaon, India.
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