• Humans
• Nomograms
• Liver Transplantation/adverse effects
• Male
• Female
• Middle Aged
• Retrospective Studies
• Adult
• Risk Factors
• Postoperative Complications/etiology
• Postoperative Complications/epidemiology
• Postoperative Complications/diagnosis
• Risk Assessment/methods
• Hepatic Artery/physiopathology
• Tissue Donors
• Vascular Resistance
• Biliary Tract Diseases/etiology
• Biliary Tract Diseases/diagnosis
• Biliary Tract Diseases/epidemiology

• Contrast-enhanced CT
• Liver transplant
• Portal vein thrombus
• Splenoportography
• Varix of the portal vein

• contrast-enhanced ultrasound
• diagnosis
• image
• post-transplant lymphoproliferative disease
• transplant liver

• hematoma
• mesh hernioplasty complications
• mesh repair
• post-operative seroma
• surgical wound infection

• Child
• Computed tomography
• Liver transplantation
• Magnetic resonance imaging
• Ultrasonography

• Child
• Humans
• Liver Transplantation
• Ultrasonography
• Tomography, X-Ray Computed
• Magnetic Resonance Imaging/methods
• Radiology

• Universitätsklinikum Hamburg-Eppendorf (UKE) (5411)

• Child
• Computed tomography
• Liver transplantation
• Magnetic resonance imaging
• Ultrasonography

• Child
• Humans
• Liver Transplantation
• Ultrasonography
• Magnetic Resonance Imaging/methods
• Ultrasonography, Doppler
• Radiology
• Postoperative Complications/diagnostic imaging

• Universitätsklinikum Hamburg-Eppendorf (UKE) (5411)

• Humans
• Case-Control Studies
• Retrospective Studies
• Ascites
• Liver Diseases
• Tomography, X-Ray Computed/methods
• Magnetic Resonance Imaging
• Edema

• CT scan
• artificial intelligence
• imaging biomarkers
• machine learning
• prognostic model

• Humans
• Infant
• Pilot Projects
• Artificial Intelligence
• Liver Transplantation
• Retrospective Studies
• Fibrosis

• Bile leak
• Biliary stones
• Biliary strictures
• Hepatic artery thrombosis
• Liver transplantation complications
• Portal vein stenosis
• Posttransplant lymphoproliferative disorder
• Recurrent hepatocellular carcinoma

• Cholangiopancreatography, Endoscopic Retrograde
• Cholestasis/diagnosis
• Cholestasis/etiology
• Cholestasis/surgery
• Constriction, Pathologic/complications
• Humans
• Liver Transplantation/adverse effects
• Living Donors
• Postoperative Complications/etiology
• Retrospective Studies
• Treatment Outcome

• COVID-19/diagnostic imaging
• COVID-19/epidemiology
• COVID-19 Testing
• Contrast Media
• Humans
• Immunocompromised Host
• Liver/diagnostic imaging
• Liver Transplantation/methods
• Magnetic Resonance Imaging
• Pandemics
• Practice Guidelines as Topic
• Tissue Donors
• Tomography, X-Ray Computed
• Ultrasonography, Doppler, Color/methods

The aim of this study was to evaluate longitudinal changes of post-liver transplantation (LT) biliary anatomy and to assess the association of increased laboratory values after LT with the development of post-LT anastomotic biliary stricture (ABS).

Adult deceased donor LT recipients from 2008 and 2019 were evaluated. ABS was defined after blinded review of endoscopic cholangiograms. Controls were patients who underwent LT for hepatocellular carcinoma who did not have any clinical or biochemical concerns for ABS.

Of 534 patients who underwent LT, 57 patients had ABS and 57 patients served as controls. On MRI, ABS patients had a narrower anastomosis (2.47 ± 1.32 mm vs. 3.38 ± 1.05 mm; p < 0.01) and wider bile duct at 1-cm proximal to the anastomosis (6.73 ± 2.45 mm vs. 5.66 ± 1.95 mm; p = 0.01) than controls. Association between labs at day 7 and ABS formation was as follows: aspartate aminotransferase hazard ratio (HR): 1.014; 95% confidence interval (CI): 1.008–1.020, p = 0.001; total bilirubin HR: 1.292, 95% CI: 1.100–1.517, p = 0.002; and conjugated bilirubin HR: 1.467, 95% CI: 1.216–1.768, p = 0.001. Corresponding analysis results for day 28 were alanine aminotransferase HR: 1.004, 95% CI: 1.002–1.006, p = 0.001; alkaline phosphatase HR: 1.005, 95% CI: 1.003–1.007, p = 0.001; total bilirubin HR: 1.233, 95% CI: 1.110–1.369, p = 0.001; and conjugated bilirubin HR: 1.272, 95% CI: 1.126–1.437, p = 0.001.

Elevation of laboratory values early after LT is associated with ABS formation.

• Bile ducts
• Cholangiopancreatography
• Common bile duct
• Liver transplantation
• Magnetic resonance imaging
• endoscopic retrograde

• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• End Stage Liver Disease
• Follow-Up Studies
• Graft Rejection/diagnosis
• Humans
• Liver/pathology
• Liver Neoplasms/diagnosis
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Liver Transplantation/adverse effects
• Neoplasm Recurrence, Local/pathology
• Recurrence
• Severity of Illness Index

• Imaging
• Indication for liver transplantation
• Liver malignancies
• Liver transplantation
• Survival

• Complications
• Liver transplantation
• Living liver donor transplantation
• Magnetic resonance imaging
• Orthotopic liver transplantation

Background: Contrasting results have emerged from limited studies investigating the role of prophylactic surgical drainage in preventing wound morbidity after liver and kidney transplantation. This retrospective study analyzes the use of surgical drain and the incidence of wound complications in combined liver and kidney transplantation (CLKTx).

Methods: A total of 55 patients aged ≥18 years were divided into two groups: the drain group (D) (n = 35) and the drain-free group (DF) (n = 20). Discretion to place a drain was based exclusively on surgeon preference. All deceased donor kidneys were connected to the LifePort Renal Preservation Machine® prior to transplantation, in both simultaneous and delayed technique of implantation of the renal allograft. The primary outcome was the development of superficial/deep wound complications during the study follow-up. Secondary outcomes included the development of delayed graft function (DGF) of the transplanted kidney, primary non-function (PNF) and early allograft dysfunction (EAD) of the transplanted liver, graft failure, graft and patient survival, overall post-operative morbidity rate and length of hospital stay.

Results: With a median follow-up of 14.4 months after transplant, no difference in the incidence of superficial/deep wound complications, except for hematomas, in collections size, intervention rate, PNF, EAD, graft failure and patient survival, was observed between the 2 groups. Significantly lower level of platelets, higher INR values, DGF, morbidity rates and length of hospital stay were reported post-operatively in the D group. Pre-operative hypoalbuminemia and longer CIT were included in the propensity score for receiving a drain and were associated with a significantly higher rate of developing a hematoma post-transplant.

Conclusions: Absence of the surgical drain did not appear to adversely affect wound morbidity compared to the prophylactic use of drains in renal transplant patients during CLKTx.

• DGF
• combined liver and kidney transplantation
• graft failure
• prophylactic drainage
• wound complications

• Complications
• Contrast-enhanced ultrasound
• Liver
• Postoperative
• Transplantation
• Ultrasound imaging

• Computed tomography
• Liver transplantation
• Living liver donor transplantation
• Magnetic resonance imaging
• Orthotopic liver transplantation

Early hepatic artery thrombosis (eHAT) is a severe arterial complication leading to biliary complications and graft failure in living donor liver transplantation (LDLT). This study sought to early identify the abnormal waveforms of eHAT by using intensive Doppler ultrasonography (DUS) after LDLT and to assess the clinical outcome in these eHAT patients.

DUS for 419 adult LDLT recipients was performed twice after vascular anastomosis during liver transplantation and once a day at the bedside for at least 2 weeks.

Nine adult LDLT recipients with eHAT were identified by using bedside DUS with subsequent computed tomography angiography (CTA). All eHAT cases were noted in the first 2 weeks. Five patients with CTA findings of partial thrombus with the small visualized intrahepatic hepatic artery (HA) were treated with intravenous thrombolysis (IVT) (medical group). Another 4 patients with CTA findings of extrahepatic HA occlusion and nonvisualization of intrahepatic HAs were treated by arterial re-anastomosis (surgical group). The prevalence of long-term non-anastomotic biliary strictures was 33.3% in the surgical group. Intensive post-LDLT DUS is a convenient and sensitive tool for eHAT detection.

Subsequent CTA gives valid information on occluded arteries and associated findings, which impact decision-making and are correlated with patient outcome. Our protocol of DUS has high sensitivity and diagnostic accuracy for use in in eHAT patients with partial occlusion, and it can be applied for IVT treatment, avoiding the need for reoperation and preventing long-term biliary complications.

Hepatic artery aneurysms have an estimated incidence of approximately 0.002%, of which one half are pseudoaneurysms (PsAs). These typically occur following trauma or liver transplant and are often asymptomatic. An uncommon pathology, mycotic aneurysms or PsAs are those that result as a consequence of infections. The danger in mycotic processes stems from their complications of systemic seeding of infection, rupture, and possible exsanguination. This case reports a mycotic PsA that was found in an accessory left hepatic artery (aLHA) branching from the left gastric artery (LGA). The patient presented with recurrent Clostridium difficile colitis with perforation and was later found to have a left upper quadrant vascular lesion during repeat imaging after failing to progress in their clinical course. After multidisciplinary meetings with vascular surgery and interventional radiology, the patient eventually underwent endovascular coil embolization. This is the first documented case of a mycotic PsA secondary to recurrent C. difficile colitis located in an aLHA branching from the LGA.

• accessory left hepatic artery
• case report
• endovascular aneurysm repair
• mycotic pseudoaneurysm

Clinical manifestations of liver transplantation complications can be subtle and non-specific. Medical imaging, mainly Doppler ultrasound, plays an important role to detect and grade these. Colour Doppler ultrasound exams are routinely performed at 24–48 h, on the 7th day, the first and third month after transplantation. MDCT and MR images are acquired based on the Doppler ultrasound (DUS) findings, even in the absence of abnormal liver function. As vascular complications appear early after surgery, DUS should be performed by experience personnel. Diagnostic angiography is seldom performed. This pictorial review illustrates the key imaging findings of vascular complications in patients with liver transplantation: hepatic artery complications (such as thrombosis, stenosis of the anastomosis and pseudoaneurysms), portal vein abnormalities (such as occlusion and stenosis) and hepatic veins and/or inferior vena cava flow changes (Budd-Chiari syndrome).

• Doppler ultrasound
• Graft complications
• Liver imaging
• Liver transplantation
• Vascular abnormalities

• 3T device
• Biliary complications
• Biliary strictures
• Liver transplantation
• MR cholangiopancreatography
• MR imaging

• Biliary complications
• Complicaciones biliares
• Complicaciones vasculares
• Computed tomography
• Doppler ultrasonography
• Ecografía Doppler
• Interventional radiology
• Liver transplantation
• Magnetic resonance imaging
• Radiología intervencionista
• Resonancia magnética
• Tomografía axial computarizada
• Trasplante hepático
• Vascular complications

• Biliary strictures
• Endoscopic management
• Living donor liver transplantation
• Self-expanding metal stents
• Stenting

• Anastomosis, Surgical/adverse effects
• Biliary Tract/diagnostic imaging
• Biliary Tract/pathology
• Catheterization/methods
• Cholangiopancreatography, Endoscopic Retrograde/instrumentation
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Cholangiopancreatography, Endoscopic Retrograde/standards
• Cholangiopancreatography, Endoscopic Retrograde/trends
• Cholestasis/diagnostic imaging
• Cholestasis/etiology
• Cholestasis/therapy
• Constriction, Pathologic/diagnostic imaging
• Constriction, Pathologic/etiology
• Constriction, Pathologic/therapy
• Humans
• Liver Transplantation/adverse effects
• Liver Transplantation/methods
• Living Donors
• Practice Guidelines as Topic
• Self Expandable Metallic Stents
• Treatment Outcome

• Bile ducts
• Blood group incompatibility
• Computed tomography
• Liver transplantation
• Outcome

Hepatic artery pseudoaneurysm (HAP) incidence is rising due to more common use of endoscopic and percutaneous hepatic interventions. HAP is potentially fatal, as it could lead to sudden life-threatening hemorrhage. HAP can be intrahepatic or extrahepatic. On computed tomography angiogram (CTA) and magnetic resonance angiogram (MRA), HAP follows blood pool on multiphasic examination, with brisk arterial enhancement that washes out, similar to the abdominal aorta on later phases. We present a case of idiopathic giant HAP in an 82-year-old male. Currently, angioembolization is replacing surgery as the initial modality of choice for management of this condition.

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a recently introduced technique aimed to perform two-stage hepatectomy in patients with a variety of primary or secondary neoplastic lesions. ALPSS is based on a preliminary liver resection associated with ligation of the portal branch directed to the diseased hemiliver (DH), followed by hepatectomy after an interval of time in which the future liver remnant (FLR) hypertrophied adequately (partly because of preserved arterialization of the DH). Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) play a pivotal role in patients’ selection and FLR assessment before and after the procedure, as well as in monitoring early and late complications, as we aim to review in this paper. Moreover, we illustrate main abdominal MDCT and MRI findings related to ALPPS.

• Hepatectomy
• Computed tomography
• Magnetic resonance imaging
• Associating liver partition and portal vein ligation for staged hepatectomy
• Liver surgery

• Computed tomography
• Liver transplant
• Magnetic resonance imaging
• Ultrasonography

• Biliary stricture
• Diagnostic accuracy
• Endoscopic retrograde cholangiopancreatography
• Liver transplant

• Liver transplantation
• arteria lienalis steal syndrome
• biliary duct
• contrast-enhanced ultrasound (CEUS)
• ultrasound
• vascular complications

The diagnostic value of common ultrasound and contrast-enhanced ultrasonography (CEUS) in hepatic artery pseudoaneurysm (HAP) after liver transplantation was investigated. From January 2005 to November 2015, information was collected on 2,085 cases of orthotopic liver transplantation. The cases included 1,617 men and 468 women. Common ultrasound and CEUS were used to monitor arterial blood flow following surgery, and the complications were assessed. Instruments used included Acuson Sequoia 512 and Mylab Twice, and the contrast agent was SonoVue. The standard of common ultrasound in the diagnosis of HAP was follicular structure, which had arterial blood flow signal present beside the hepatic artery. The diagnostic criteria of HAP using CEUS were abnormal and round contrast enhancement zone and perfusion of the contrast agent in the zone near the hepatic artery. The diagnostic standard of HAP was computed tomographic angiography (CTA) and emergency operation. Eight cases of HAP were diagnosed in 2,085 patients after liver transplantation (0.38%). Three cases of HAP were diagnosed successfully by common ultrasound while 5 cases were missed. Sensitivity, specificity and diagnostic accuracy for common ultrasound was 37.5, 100 and 99.76%, respectively. Six cases of HAP were diagnosed by CEUS and 2 cases were missed. Sensitivity, specificity and diagnostic accuracy for CEUS was 75, 100 and 99.9%, respectively. Collectively, CEUS is a convenient and effective diagnostic method for HAP following liver transplantation, the diagnostic sensitivity was obviously higher than that of the common ultrasound, and it was more convenient than CTA. Nevertheless, the diagnosis of pseudoaneurysm with deep location, and unsatisfactory grayscale images were easily missed.

• contrast-enhanced ultrasound
• hepatic artery pseudoaneurysm
• liver transplantation
• ultrasound

The liver is the second most-often transplanted solid organ after the kidney, so it is clear that liver disease is a common and serious problem around the globe. With the advancements in surgical, oncological and imaging techniques, orthotopic liver transplantation has become the first-line treatment for many patients with end-stage liver disease. Ultrasound, and Doppler are the most economical and cost-effective imaging modalities for evaluating postoperative fluid collections and vascular complications. Computed tomography (CT) is used to confirm the findings of ultrasound and look for pulmonary complications. Magnetic resonance imaging (MRI) is used for the diagnosis of biliary complications, bile leaks and neurological complications. This article illustrates the imaging options for diagnosing the various complications that can be encountered in the postoperative period after liver transplantation.

• imaging
• liver transplant
• postoperative complications

Biliary tract diseases are the most common complications following liver transplantation (LT) and usually include biliary leaks, strictures, and stone disease. Compared to deceased donor liver transplantation in adults, living donor liver transplantation is plagued by a higher rate of biliary complications. These may be promoted by multiple risk factors related to recipient, graft, operative factors and post-operative course. Magnetic resonance cholangiopancreatography is the first-choice examination when a biliary complication is suspected following LT, in order to diagnose and to plan the optimal therapy; its limitations include a low sensitivity for the detection of biliary sludge. For treating anastomotic strictures, balloon dilatation complemented with the temporary placement of multiple simultaneous plastic stents has become the standard of care and results in stricture resolution with no relapse in > 90% of cases. Temporary placement of fully covered self-expanding metal stents (FCSEMSs) has not been demonstrated to be superior (except in a pilot randomized controlled trial that used a special design of FCSEMSs), mostly because of the high migration rate of current FCSEMSs models. The endoscopic approach of non-anastomotic strictures is technically more difficult than that of anastomotic strictures due to the intrahepatic and/or hilar location of strictures, and the results are less satisfactory. For treating biliary leaks, biliary sphincterotomy and transpapillary stenting is the standard approach and results in leak resolution in more than 85% of patients. Deep enteroscopy is a rapidly evolving technique that has allowed successful treatment of patients who were not previously amenable to endoscopic therapy. As a result, the percutaneous and surgical approaches are currently required in a minority of patients.

• Biliary stricture
• Bile leakage
• Liver transplantation
• Endoscopic retrograde cholangio-pancreatography
• Plastic stents
• Fully-covered self-expandable metal stents