Hepatic transplantation: postoperative complications
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Abdominal Imaging
Abdom Imaging (2013) DOI: 10.1007/s00261-013-0002-z
Hepatic transplantation: postoperative complications Jason N. Itri,1 Matthew T. Heller,2 Mitchell E. Tublin2 1 2
University of Pittsburgh Medical Center, 200 Lothrop Street Presby South Tower, Suite 4896, Pittsburgh, PA, USA University of Pittsburgh Medical Center, 200 Lothrop Street Presby South Tower, Suite 3950, Pittsburgh, PA, USA
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 posttransplant 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. Key words: Liver transplant—Complication—OLTX
Long-term graft and patient survival after orthotopic liver transplantation (OLTX) for end-stage liver disease has improved significantly over the last 3 decades as a result of improvements in patient selection and periop-
Correspondence to: Jason N. Itri; email: [email protected]
erative management, modifications in surgical technique, refinements in organ preservation, and the introduction of more effective immunosuppressive agents. The early detection and treatment of postoperative complications has also contributed to reduced post-transplant morbidity and mortality. Currently, 1-year, 3-year, and 5-year graft survival rates after OLTX are 83 %, 74 %, and 67 %, whereas 1-year, 3-year, and 5-year patient survival rates are 88 %, 80 %, and 74 %, respectively [1]. Complications that can lead to graft failure or patient mortality include vascular abnormalities, biliary strictures and leaks, infection, allograft rejection, and recurrent or post-transplant malignancy [2]. In this article, we describe and illustrate the imaging appearances and management of complications associated with l
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