Abstract
Liver transplantation has become a successful surgical solution to a variety of medical and oncological parenchymal liver diseases. As a result, these patients are being encountered more frequently within diagnostic imaging departments which may be remote from the transplant centre. Radiologists must therefore be proficient in identifying normal post-transplant anatomy which involves the anastomosis of four structures between the donor and recipient, namely the hepatic artery, the main portal vein, the retro-hepatic inferior vena cava and the extra-hepatic bile ducts. A number of potential complications can arise involving any or all of these structures, which can be potentially devastating and lead to graft failure. Radiologists must familiarise themselves with the normal post-operative appearances of liver transplantation and become competent in diagnosing post-transplant complications. Where possible, complications should be treated using interventional radiological techniques, thus avoiding the need for repeat surgical intervention or retransplantation.
Highlights
Liver transplantation has become a successful surgical solution to a variety of medical and oncological parenchymal liver diseases
Arterial steal syndrome is a recently described complication of orthotopic liver transplantation characterized by arterial hypoperfusion of the graft resulting from a shift in blood flow into other arteries that originate from the same trunk
Stenosis usually occurs at the donorrecipient anastomosis and is most commonly seen in paediatric cases due to size mismatch between donor and recipient portal veins [13, 14]
Summary
Vascular mechanical complications occur most frequently in the transplanted hepatic artery and may be divided into steno-occlusive and nonocclusive. Steno-occlusive is a collective term describing arterial obstruction including hepatic artery thrombosis, stenosis and kinking. — The normal hepatic arterial waveform demonstrates a rapid systolic upstroke with continuous diastolic flow. The systolic acceleration time (SAT) is the time from end-diastole to the first systolic peak should be less than 0.08 seconds. — Coeliac axis angiogram in the arterial phase demonstrating filling defect just distal to the origin of the common hepatic artery Fig. 2. — Coeliac axis angiogram in the arterial phase demonstrating filling defect just distal to the origin of the common hepatic artery
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