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World J Gastroenterol. May 28, 2014; 20(20): 6180-6200
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6180
Post-operative imaging in liver transplantation: State-of-the-art and future perspectives
Rossano Girometti, Giuseppe Como, Massimo Bazzocchi, Chiara Zuiani
Rossano Girometti, Giuseppe Como, Massimo Bazzocchi, Chiara Zuiani, Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, University of Udine, 33100 Udine, Italy
Author contributions: Girometti R and Como G wrote the paper; Girometti R, Como G, Bazzocchi M and Zuiani C designed the paper; Como G, Bazzocchi M and Zuiani C performed literature research; all the authors selected and supervised the editing of study images and tables.
Correspondence to: Dr. Rossano Girometti, MD, Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, University of Udine, via Colugna 50, 33100 Udine, Italy.
Telephone: +39-43-2559266 Fax: +39-43-2559867
Received: October 24, 2013
Revised: November 14, 2013
Accepted: January 19, 2014
Published online: May 28, 2014

Orthotopic liver transplantation (OLT) represents a major treatment for end-stage chronic liver disease, as well as selected cases of hepatocellular carcinoma and acute liver failure. The ever-increasing development of imaging modalities significantly contributed, over the last decades, to the management of recipients both in the pre-operative and post-operative period, thus impacting on graft and patients survival. When properly used, imaging modalities such as ultrasound, multidetector computed tomography, magnetic resonance imaging (MRI) and procedures of direct cholangiography are capable to provide rapid and reliable recognition and treatment of vascular and biliary complications occurring after OLT. Less defined is the role for imaging in assessing primary graft dysfunction (including rejection) or chronic allograft disease after OLT, e.g., hepatitis C virus (HCV) recurrence. This paper: (1) describes specific characteristic of the above imaging modalities and the rationale for their use in clinical practice; (2) illustrates main imaging findings related to post-OLT complications in adult patients; and (3) reviews future perspectives emerging in the surveillance of recipients with HCV recurrence, with special emphasis on MRI.

Keywords: Orthotopic liver transplantation, Ultrasound, Computed tomography, Magnetic resonance imaging, T-tube cholangiography, Endoscopic retrograde cholangiography, Percutaneous transhepatic cholangiography, Orthotopic liver transplantation complications, Human C virus recurrence

Core tip: Complications after orthotopic liver transplantation (OLT) still constitute a significant cause of morbidity and graft loss. Prompt diagnosis is then essential in order to address patients to most proper treatment and assure graft and patient survival, especially in the case of vascular and biliary complications. The review focuses on: (1) the state-of-the-art role for different imaging modalities in assessing post-OLT complications, together with practical recommendations for their use; and (2) future perspective for quantitative imaging modalities in non-invasively assessing primary hepatic complications (for which the role of conventional imaging is still limited), using human C virus recurrence as the most exemplificative scenario.