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Complications of Orthotopic Liver Transplantation: Spectrum of Findings with Helical CT¹

¹ From the Department of Radiology and Institut de Diagnòstic per la Imatge (S.Q., M.C.S., R.B., A.A.C.), the Liver Transplantation Unit (C.M.), and the Liver Unit (L.C.), Hospital General Universitari Vall d’Hebron, Passeig Vall d’Hebron 119–129, 08035 Barcelona, Spain. Presented as an education exhibit at the 2000 RSNA scientific assembly. Received February 27, 2001; revision requested April 6 and received May 16; accepted May 16. Address correspondence to S.Q. (e-mail: squiroga@hg.vhebron.es).

Orthotopic liver transplantation has become the treatment of choice for patients with end-stage nonmalignant liver disease. The surgical techniques and immunosuppressive therapy for this procedure have improved considerably. Nevertheless, there are still significant complications, particularly those of vascular origin, which can lead to graft failure and require retransplantation unless prompt treatment is instituted. These complications include arterial and venous thrombosis and stenosis; arterial pseudoaneurysm; biliary leakage, stricture, and obstruction; liver ischemia, infarction, and abscess; fluid collections and hematomas; lymphoproliferative disorders; recurrent tumors; hepatitis C virus infection; and splenic infarction. Since the clinical presentation of posttransplantation complications is frequently nonspecific and varies widely, imaging studies are critical for early diagnosis. Helical computed tomography (CT) is a valuable complement to ultrasonography (US) in the postoperative period and is a safe, accurate, and noninvasive method of demonstrating hepatic vessels (hepatic artery, portal vein, hepatic veins, and inferior vena cava) and evaluating nonvascular complications (in the hepatic parenchyma and bile duct abnormalities) and extrahepatic tissues. Knowledge and early recognition of these complications is essential for graft salvage, and CT can provide valuable information, particularly for patients with indeterminate US results or in whom US examination is difficult.

Index Terms: Computed tomography (CT), helical, 76.12115 • Liver, CT, 76.12115 • Liver, transplantation, 76.451, 76.458

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