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Brookmeyer CE, Bhatt S, Fishman EK, Sheth S. Multimodality Imaging after Liver Transplant: Top 10 Important Complications. Radiographics 2022; 42:702-721. [PMID: 35245104 DOI: 10.1148/rg.210108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients who have undergone liver transplant are now regularly seen in day-to-day radiology practice. All surgical techniques for liver transplant require arterial, portal venous, hepatic venous and caval, and biliary anastomoses. This review is focused on the 10 "not to be missed" complications of liver transplant that affect the health and life of the graft and graft recipient. Arterial complications are the most common and devastating. Early hepatic artery thrombosis may be catastrophic because the biliary tree is solely dependent on the hepatic artery after transplant and collateral vessels have not yet formed. In contrast, delayed hepatic artery thrombosis may be more insidious as collateral arteries develop. US findings of delayed hepatic artery thrombosis may be similar to those of hepatic artery stenosis and celiac artery stenosis. Splenic artery steal syndrome is an increasingly recognized cause of graft ischemia. Venous complications are much less common. Hepatic venous and caval complications are notable for their increased incidence in living-donor and pediatric transplants. Biliary complications often result from arterial ischemia. Biliary cast syndrome is a notable example in which ischemic biliary mucosa sloughs into and obstructs the duct lumens. Neoplasms also may occur within the hepatic graft and may be due to recurrent malignancy, posttransplant lymphoproliferative disorder, or metastases. US is the initial imaging modality of choice, particularly in the acute postoperative setting. Further evaluation with contrast-enhanced US, CT, or MRI; catheter angiography; endoscopic retrograde cholangiopancreatography; and/or nuclear medicine studies is performed as needed. An invited commentary by Bhargava is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Claire E Brookmeyer
- From the Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287 (C.E.B., E.K.F.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.); and Department of Radiology, New York University Langone Health, New York, NY (S.S.)
| | - Shweta Bhatt
- From the Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287 (C.E.B., E.K.F.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.); and Department of Radiology, New York University Langone Health, New York, NY (S.S.)
| | - Elliot K Fishman
- From the Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287 (C.E.B., E.K.F.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.); and Department of Radiology, New York University Langone Health, New York, NY (S.S.)
| | - Sheila Sheth
- From the Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD 21287 (C.E.B., E.K.F.); Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.); and Department of Radiology, New York University Langone Health, New York, NY (S.S.)
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Abstract
PURPOSE OF REVIEW Hepatolithiasis is a disease characterized by intrahepatic stone formation. In this article, we review the features of this disease and explore the established and emerging treatment modalities. RECENT FINDINGS Recent reports show an increasing prevalence of hepatolithiasis, likely owed to increased immigration and shifts in the Western diet. New pharmacotherapy options are limited and are often only supportive. Endoscopic intervention still cruxes on removal of impacted stones, though new techniques such as bile duct exploratory lithotomy and lithotripsy continue to advance management. Although hepatectomy of the effected portion of the liver offers definitive therapy, alternative less invasive modalities such as combined endoscopic/interventional radiology modalities have been utilized in select patients. Additionally, liver transplant serves as an option for otherwise incurable hepatolithiasis with coexisting liver dysfunction. Multiple emerging pharmacologic and procedural interventions may provide novel treatment for hepatolithiasis. While definitive therapy remains resection of affected liver segments, these modalities offer hope for less invasive approaches in the future.
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