Sonography of liver transplantation
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SPECIAL SECTION: LIVER TRANSPLANTATION
Sonography of liver transplantation Ekta Maheshwari1 · Mitchell E. Tublin1 Received: 7 June 2020 / Revised: 27 September 2020 / Accepted: 29 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Orthotopic liver transplant (OLT) is established as the definitive treatment of choice for end stage liver disease. Over the years, refined surgical techniques as well as advancements in organ preservation and immunosuppressive regimens have improved graft and patient survival rates. Imaging has also contributed to improved graft and patient survival. Ultrasound is the initial investigation of choice for evaluation of post-transplant anatomy and for identifying early complications. A thorough knowledge of surgical techniques and normal post-operative appearance of the OLT is needed to accurately identify and characterize graft complications. The objective of this article is to review the sonographic findings of normal liver transplant as well as post-operative complications. Indications and contraindications for OLT as well as different surgical techniques will also be briefly reviewed. Keywords Ultrasound · Liver transplant · Normal post-operative findings
Introduction Orthotopic liver transplant (OLT) is established and accepted as the only definitive treatment for patients with end stage liver disease. Dr. Thomas Starzl performed the first successful liver transplant in the 1960s [1]. Initial results were not promising; however, refined surgical techniques, improved organ preservation and dramatic refinements in immunosuppressive regimens have steadily improved post-operative graft and patient survival rates. Organ Procurement and Transplantation Network (OPTN) data have shown that from January 1, 1988 to August 31, 2019—170,100 patients underwent liver transplantation in the United States. 8250 patients received liver transplants in 2018 alone [2]. A large number of patients remain on transplant wait lists, however. Cross-sectional imaging has clearly played an unheralded role in improving graft and patient survival rates over the past 30 years. Radiologists need to be aware of the utility of imaging—predominantly ultrasound—for depicting * Ekta Maheshwari [email protected] Mitchell E. Tublin [email protected] 1
Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15123, USA
potentially correctable causes of liver allograft dysfunction, given the continuing shortage of organs and the individualsocietal costs of liver disease and curative transplantation. Pre-operative radiologic evaluation is directed at selecting patients suitable for OLT and for defining anatomy that may necessitate altered surgical approaches. Post-operative imaging studies are directed at detecting immediate and late complications including vascular abnormalities, biliary leaks and strictures, perigraft hematoma and collections, infection, rejection and malignancy. A thorough understanding of surgi
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