title: Graft complications following orthotopic liver transplantation: Role of non-invasive cross-sectional imaging techniques.
abstract: Orthotopic liver transplantation is the treatment of choice in adult patients with endstage liver disease. Survival of both graft and patient has progressively improved over time due to improvements in surgical and medical treatment. However, post-transplant complications still have a significant impact on morbidity and mortality associated with transplant surgery. The most common adverse events of the graft include vascular (arterial and venous stenosis and thrombosis), biliary (leakage, strictures, stones) and parenchymal complications (hepatitis virus C infection, HCC recurrence, liver abscesses). The diagnosis of these adverse events is often challenging because of the low specificity of clinical and biologic findings. Different diagnostic algorithms have been proposed for the detection of graft complications and, in this setting, radiological evaluation plays a key role in differential diagnosis of graft complications and the exclusion of other adverse events. Ultrasound examination is established the first-line method of identifying adverse events in liver transplant recipients but a normal or a technically unsatisfactory study cannot exclude the presence of biliary, vascular and/or parenchymal complications. In these circumstances, before planning any treatment, multi-detector CT and/or MR imaging and MR cholangiography should be performed for the evaluation of vascular structures, biliary system, liver parenchyma and fluid collections. The aim of this review is to illustrate the role and state-of-the-art of non-invasive cross-sectional imaging techniques in the diagnosis and management of complications which primarily affect the graft in patients after liver transplantation.
authors.affiliation: 2nd Unit of Radiology-Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy. Electronic address: p.boraschi@do.med.unipi.it.
authors.forename: Piero
authors.initials: P
authors.lastname: Boraschi
authors.affiliation: 2nd Unit of Radiology-Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy.
authors.forename: Maria Clotilde
authors.initials: MC
authors.lastname: Della Pina
authors.affiliation: 2nd Unit of Radiology-Department of Diagnostic Radiology, Vascular and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy.
authors.forename: Francescamaria
authors.initials: F
authors.lastname: Donati
mesh_terms: D002758:Cholangiography / Q000379:methods*; D003287:Contrast Media; D003937:Diagnosis, Differential; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D016031:Liver Transplantation / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media
keywords: Contrast-enhanced MR cholangiography; Graft complications; Liver transplantation; MR cholangiography; MR imaging; Multidetector CT