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Shampain KL, Liles AL, Chong ST. Imaging of Transplant Emergencies. Semin Roentgenol 2020; 55:115-131. [PMID: 32438975 DOI: 10.1053/j.ro.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Amber L Liles
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
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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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Segedi M, Buczkowski AK, Scudamore CH, Yoshida EM, Harris AC, DeGirolamo K, Chung SW. Biliary and vascular anomalies in living liver donors: the role and accuracy of pre-operative radiological mapping. HPB (Oxford) 2013; 15:732-9. [PMID: 23458411 PMCID: PMC3948542 DOI: 10.1111/hpb.12042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 11/28/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of the present study was to determine the utility of computed tomography (CT) and magnetic resonance imaging (MRI) anatomic mapping in the detection of biliary and vascular anomalies prior to a living liver donor (LLD) operation. METHODS A retrospective study of all LLD patient charts, operative and radiology reports from 1 January 2002 to 1 January 2012 was conducted. Primary post-operative outcomes assessed included mortality, re-operation, readmission and need for endoscopic or percutaneous intervention. Sensitivity and specificity of MR and CT pre-operative screening was calculated against the gold standard of intra-operative findings. RESULTS A total of 34 donors had an average age of 38 years (range: 22-58) with a body mass index (BMI) of 25.6 kg/m(2) (range: 19.8-32.5) and a length of stay (LOS) of 10.1 days (range: 5-41). There were no donor mortalities. Sensitivity and specificity of CT was 70.0% and 91.3%, and of MRI screening 23.1% and 100.0%, respectively. Patients with inaccurate pre-operative CT or MRI did not have an increased risk of complications. CONCLUSIONS Even although it was specific, pre-operative MR screening missed up to 77.0% of biliary anomalies. An impeccable surgical technique remains the key in preventing biliary complications of a living donor hepatectomy where pre-operative MRI screening is false.
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Affiliation(s)
- Maja Segedi
- Department of Surgery, University of British ColumbiaVancouver, BC, Canada,Correspondence Maja Segedi, Gordon & Leslie Diamond Health Care Centre, 2775 Laurel Street, 5th Floor, Vancouver, BC V5Z 1 M9, Canada. Tel: +1 604 875 4459. Fax: +1 604 675 3973. E-mail:
| | | | | | - Eric M Yoshida
- Department of Medicine, University of British ColumbiaVancouver, BC, Canada
| | - Alison C Harris
- Department of Radiology, University of British ColumbiaVancouver, BC, Canada
| | - Kristin DeGirolamo
- Undergraduate Medicine, University of British ColumbiaVancouver, BC, Canada
| | - Stephen W Chung
- Department of Surgery, University of British ColumbiaVancouver, BC, Canada
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Kothary N, Patel AA, Shlansky-Goldberg RD. Interventional radiology: management of biliary complications of liver transplantation. Semin Intervent Radiol 2011; 21:297-308. [PMID: 21331141 DOI: 10.1055/s-2004-861564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Major advances in the field of liver transplantation have led to an increase in both graft and patient survival rates. Despite increased graft survival rate, biliary complications lead to significant postoperative morbidity and even mortality. A multidisciplinary approach to these complications is critical. As part of the team approach, less invasive techniques used by the interventional radiologist have an increasing role in the management of complications after liver transplantation. This paper will review the current role of the interventionalist in management of biliary complications.
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Affiliation(s)
- Nishita Kothary
- Division of Vascular and Interventional Radiology, Columbia University Medical Center, New York, New York
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Catalano OA, Sahani DV, Forcione DG, Czermak B, Liu CH, Soricelli A, Arellano RS, Muller PR, Hahn PF. Biliary Infections: Spectrum of Imaging Findings and Management. Radiographics 2009; 29:2059-80. [DOI: 10.1148/rg.297095051] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Gallbladder and biliary system pathologic component is a spectrum of benign and malignant conditions. Standard magnetic resonance imaging techniques when used together with magnetic resonance cholangiopancreatography (MRCP) can evaluate gallbladder and biliary system pathologic conditions. Inflammatory diseases are characterized by thickening and intense mucosal contrast enhancement of the affected bile ducts and or gallbladder wall. Postinflammatory changes can be appreciated on MRCP with short or long segment strictures of the bile ducts. Serial contrast-enhanced images show reactive inflammatory changes in the liver parenchyma. Neoplastic diseases of the gallbladder and the biliary tree are evaluated on T2-weighted fat-suppressed echo train and serial contrast-enhanced images and their obstructive effect can be displayed on MRCP images. In this paper, we will review the spectrum of MRI findings of gallbladder and biliary system pathologic conditions.
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Stratifying Risk of Biliary Complications in Adult Living Donor Liver Transplantation by Magnetic Resonance Cholangiography. Transplantation 2008; 85:1569-72. [PMID: 18551061 DOI: 10.1097/tp.0b013e31816ff21f] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Cho A, Asano T, Yamamoto H, Nagata M, Takiguchi N, Kainuma O, Soda H, Mori M, Narumoto S, Okazumi S, Makino H, Ochiai T, Ryu M. Relationship between right portal and biliary systems based on reclassification of the liver. Am J Surg 2007; 193:1-4. [PMID: 17188078 DOI: 10.1016/j.amjsurg.2006.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 04/23/2006] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although the anatomy of the right portal and biliary systems and their interrelationships must be understood to safely and satisfactorily perform left-sided resection of hilar cholangiocarcinoma or right-lobe living donor liver transplantation, the anatomies of the right portal and biliary systems are extremely difficult to understand. METHODS A total of 60 patients with normal liver underwent computed tomography during both portography and cholangiography to evaluate relationships between the right biliary and portal systems based on reclassification of the liver to divide the right liver into 3 segments. RESULTS All ventral and posterior ducts constantly join medially to the anterior portal trunk. In contrast, some dorsal ducts join the ventral duct medially and others join the posterior duct lateral to the anterior trunk. CONCLUSIONS Reclassification of the liver to divide the right liver into 3 segments facilitates an understanding of relationships between the right portal and biliary systems.
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Affiliation(s)
- Akihiro Cho
- Department of Surgery, Chiba Cancer Center Hospital, 666-2 Nitonachou, Chuouku, Chiba 260-8717, Japan.
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Chang JM, Lee JM, Suh KS, Yi NJ, Kim YT, Kim SH, Han JK, Choi BI. Biliary complications in living donor liver transplantation: imaging findings and the roles of interventional procedures. Cardiovasc Intervent Radiol 2006; 28:756-67. [PMID: 16160754 DOI: 10.1007/s00270-004-0262-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To describe the incidence, types, and findings of biliary complications in living donor liver transplantation (LDLT) and to determine the roles of interventional procedures. MATERIALS AND METHODS Twenty-four biliary complications among 161 LDLT patients (24/161, 14.9%) were identified. These complications were divided into two groups according to the initial manifestation time, i.e., "early" (<60 days) or "late". The CT and cholangiographic findings were reviewed regarding the presence of a stricture or leak and the location, and length, shape, and degree of the stricture. Both groups were categorized into three subgroups: leak, stricture, and both. The type of interventional procedures used and their roles were determined. RESULTS Early complications were identified in 14 of the 24 patients (58%) and late complications in 11 (46%). One patient showed both early and late complications. Biliary stricture was detected in 10 patients, leak in 10, and both in 5. By cholangiography, all strictures were irregular and short (mean length 15 +/- 6 mm) at the anastomotic site and complete obstruction was observed in 2 patients with late stricture. Twenty-three of the 24 patients were treated using percutaneous and/or endoscopic drainage procedures with or without balloon dilatation. Seventeen (74%) showed a good response, but reoperations were inevitable in 6 (26%). All patients except those with complete obstruction showed a favorable outcome after interventional management. CONCLUSION Biliary leaks and strictures are predominant complications in LDLT. Most show good responses to interventional treatment. However, complete obstruction needs additional operative management.
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Affiliation(s)
- Jung Min Chang
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
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Muraoka N, Uematsu H, Yamanouchi E, Kinoshita K, Takeda T, Ihara N, Matsunami H, Itoh H. Yamanouchi magnetic compression anastomosis for bilioenteric anastomotic stricture after living-donor liver transplantation. J Vasc Interv Radiol 2006; 16:1263-7. [PMID: 16151070 DOI: 10.1097/01.rvi.0000173280.56442.9e] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Yamanouchi magnetic compression anastomosis (YMCA) is a novel interventional method that creates an anastomosis between the bile duct and small intestine. The method uses two magnets to compress the stricture transmurally, causing gradual ischemic necrosis of the stricture. This ischemic necrosis creates an anastomosis between the two magnets. The present report describes two cases in which YMCA was successfully applied to treat bilioenteric anastomotic stricture after living-donor liver transplantation. These two patients exhibited good long-term clinical courses.
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Affiliation(s)
- Noriaki Muraoka
- Department of Radiology, University of Fukui, 23 Shimoaizuki, Matsuoka-cho, Yoshida-gun, Fukui, 910-1193, Japan.
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Abstract
The increasing awareness of liver diseases and their early detection have led to an increase in the number of transplant waiting list candidates over the past decade. This need has not been matched by the actual number of orthotopic liver transplantations performed. Live donor liver transplantation (LDLT) is an innovative surgical technique intended to expand the available organ donor pool. Although LDLT offers definite advantages to the recipient, it offers none to the donor except for the possibility of psychological well-being. Clinical research studies aimed at the prospective collection of data for donors and recipients need to be conducted.
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Affiliation(s)
- Lawrence U Liu
- Division of Liver Diseases, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1104, New York, NY 10039, USA
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Abstract
MR imaging is an established technique for the diagnosis of a spectrum of biliary and gallbladder pathologies and continues to improve with the advent of technologic advances, including new contrast agents and new sequences that are capable of improving upon the contrast resolution and signal-to-noise that are afforded by conventional MR imaging. These improvements already have shown promise for the increasing role of MRC as the initial modality in assessing living liver donors and evaluating post-operative hepato-biliary complications. Improved spatial resolution and the added functional or physiologic information afforded by MR imaging promise ever expanding clinical applicability and usefulness.
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Affiliation(s)
- Samantha L Heller
- Department of Radiology, New York University Medical Center, 530 First Avenue, New York, NY 10016, USA
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Miller GA, Yeh BM, Breiman RS, Roberts JP, Qayyum A, Coakley FV. Use of CT cholangiography to evaluate the biliary tract after liver transplantation: initial experience. Liver Transpl 2004; 10:1065-70. [PMID: 15390335 DOI: 10.1002/lt.20152] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Evaluation of the biliary tract after liver transplantation, particularly when a Roux-en-Y hepatojejunostomy precludes endoscopic retrograde cholangiography, may be challenging. We present five cases of suspected biliary obstruction after liver transplantation in which multidetector-row computed tomography (CT) cholangiography was used. In conclusion, it was determined that multidetector-row CT cholangiography may be a useful modality for demonstrating patent biliary-enteric anastomoses and excluding flow-limiting biliary anastomotic strictures.
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Affiliation(s)
- Gregg A Miller
- Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628, USA
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