Complications of orthotopic liver transplantation: Spectrum of findings with helical CT

Orthotopic liver transplantation has become the treatment of choice for pat ients with end-stage nonmalignant liver disease. The surgical techniques an d 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 retranspla ntation unless prompt treatment is instituted. These complications include arterial and venous thrombosis and stenosis; arterial pseudoaneurysm; bilia ry leakage stricture and obstruction; liver ischemia, infarction, and absce ss; fluid collections and hematomas; lymphoproliferative disorders; recurre nt tumors; hepatitis C virus infection; and splenic infarction. Since the c linical presentation of posttransplantation complications is frequently non specific and varies widely, imaging studies are critical for early diagnosi s. Helical computed tomography (CT) is a valuable complement to ultrasonogr aphy (US) in the postoperative period and is a safe, accurate, and noninvas ive method of demonstrating hepatic vessels (hepatic artery, portal vein, h epatic veins, and inferior vena Cava) and evaluating nonvascular complicati ons (in the hepatic parenchyma and bile duct abnormalities) and extrahepati c tissues. Knowledge and early recognition of these complications is essent ial for graft salvage, and CT can provide valuable information, particularl y for patients with indeterminate US results or in whom US examination is d ifficult.