Imaging in liver transplantation

Imaging in liver transplantation is aimed to evaluate donor and recipient for successful transplantation and its outcome.

Pre-transplant evaluation

Donor

• volume of liver
• parenchymal disease (diffuse or focal)
• vascular anatomy
  • arterial variations
  • venous variations
• biliary anatomy

Recipient

• vascular anatomy, e.g .arterial variations, including enlarged or diminutive vessels
• see Milan criteria

Post-transplant evaluation

Normal findings in recipient

• perihepatic hematoma
• right-sided pleural effusion
• minimal ascites
• periportal edema

Complications

• rejection (can be diagnosed accurately with biopsy only)
• related to vascular anastomosis
  • hepatic arterial thrombosis: most common vascular complication, occurring in 2-12% of transplants
  • hepatic abscess 
  • biliary ischemia / stricture 
  • arterial pseudoaneurysm
  • portal vein thrombosis/stenosis
  • hepatic vein thrombosis
  • IVC thrombosis
• related to biliary anastomosis
  • bile leak
  • biliary obstruction
    • anastomotic / non-anastomotic strictures (infection, ischemia)
    • calculus
    • cholangitis
• sepsis
• recurrent disease
• posttransplantation lymphoproliferative disease
• biliary cast syndrome
• abdominal compartment syndrome