Multidetector Computed Tomography Angiography in Detection of Active Bleeding in Renal and Liver Transplant Recipients

Abstract

Objectives The aim of this study was to evaluate the effectivity of multidetector computed tomography angiography (MDCT-A) to detect active bleeding in transplant patients. Materials and Methods Between 1999 and 2006, 532 patients underwent renal or liver transplantation. MDCT-A was performed on recipients who displayed decreased hemoglobin levels or who had a hematoma during abdominal ultrasound imaging. The MDCT-A used a 16-detector CT device (Siemens, Sensation) with slices 0.75 mm thick after injection of nonionic contrast media (4 mL per second). A multiple intensity projection (MIP) technique was used to maintain angiographic images in the axial and coronal planes. Results MDCT-A detected active bleeding among 23 posttransplant patients: 10 of arterial origin and 13 venous, as proven either by angiography or during operation. Among 8 of the 11 patients who underwent angiographic imaging the arterial origin was embolized. For three patients the angiographic evaluation was not helpful to find the bleeding point. A cohort of 5 of 12 patients did not undergo angiographic evaluation and were followed by clinical and ultrasonographic findings. Seven patients underwent re-operating. Discussion Management of the patients who were suspected to have active bleeding after renal or liver transplantation was benefitted by MDCT-A as an accurate and feasible screening modality.