Postoperative imaging of living donor liver transplantation complications

Abstract

BackgroundThere is no doubt that the role of Different diagnostic imaging is well established in the evaluation of patients who are being evaluated for potential liver transplantation but it plays a huge role in the success of transplanted liver operations. Technical advances in imaging equipment and techniques allow more accurate assessment of postoperative living donor transplantation complications. ObjectiveTo assess the role and importance of different radiological imaging modalities in evaluating and diagnosing recipient complications after living donor liver transplantation. Materials and methods50 patients who underwent living donor liver transplantation (LDLT) were followed for at least 6 months and submitted for routine investigation including laboratory tests and imaging. The biliary complications were diagnosed with ultrasound (US) but MRCP was more diagnostic over ultrasound in case of location of strictures. Endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous cholangiography (PTC) was used for therapeutic reasons. Stenting was tried in cases of biliary leakage. Doppler US was used in cases of graft rejection. CTA was used in cases whose HA (hepatic artery) couldn’t be detected by Doppler. Conventional angiography was used as a therapeutic tool for restoration of HA patency. This study was held between November 2014 until December 2016. ResultsOver 50 patients who underwent living donor liver transplantation. The morbidity rate was 66% (33 patients), where 17 patients passed an uncomplicated course, Biliary tract complications occurred in 13 patients (26%). Vascular complications were found in 8 patients (16%), one had portal vein thrombus and another patient had hepatic artery stenosis and underwent stent. Mild pleural effusion was seen in 30 patients (60%). Moderate to marked pleural effusion was seen in 13 patients (26%), Ascites was considered significant in case of moderate to marked or that persist after two weeks. Six patients complained significant collections, two of them improved by single tapping, whereas two patients required pig tail drainage (7 to14 days).The incidence of rejection was 24% in our study (12 patients) 75% of rejection (nine patients) occurred during the first two months postoperative.One case showed multiple hypodense hepatic focal lesions and the diagnosis was made by histopathology (biopsy) and was lymphoma. ConclusionThe different radiological modalities are a cornerstone in the success of the liver transplantation operation together with curious postoperative follow up are the key for diagnosis of most of the complications including vascular, biliary and collections and even rejection cases.