Top

European Radiology

Published in:

01-06-2018 | Hepatobiliary-Pancreas

Computed tomography findings in ABO-incompatible living donor liver transplantation recipients with biliary strictures

Authors: Sang Hyun Choi, Kyoung Won Kim, So Yeon Kim, Jin Sil Kim, Jae Hyun Kwon, Gi-Won Song, Sung-Gyu Lee

Published in: European Radiology | Issue 6/2018

Abstract

Objectives

To evaluate CT findings of biliary strictures in ABO-incompatible living donor liver transplantation (LDLT) recipients, with emphasis on associated 1-month post-transplantation CT findings, and evaluate clinical outcomes.

Methods

Of 351 ABO-incompatible recipients, we retrospectively evaluated CT scans in 65 recipients with biliary stricture. The biliary strictures on CT scans were classified as type A (perihilar) and type B (diffuse). Precedent CT abnormality patterns and the presence of a periportal halo sign at 1-month post-transplantation were evaluated. For each patient, clinical outcomes were evaluated.

Results

Of 65 ABO-incompatible recipients with biliary strictures, 36.9% had type B strictures. Compared with biliary strictures at diagnosis, similar CT abnormality patterns were observed for 84.4% in type A and 86.4% in type B strictures at 1-month post-transplantation. Complex periportal halo signs on the 1-month post-transplantation CT were more frequently noted for type B than type A strictures (86.4% vs. 3.1%, P < 0.001). Progressive clinical outcomes were more frequently observed for type B than type A strictures (79.2% vs. 26.8%, P < 0.001), with a significantly shorter graft survival time (46.4 months vs. 90.8 months, P < 0.001).

Conclusion

CT abnormality patterns and complex periportal halo signs on 1-month post-transplantation CT may be clinically useful for managing biliary strictures in ABO-incompatible LDLT recipients.

Key Points

• Of ABO-incompatible LDLT recipients, type B biliary stricture incidence was 6.8%.

• Of type B strictures, 86.4% exhibited similar CT abnormality patterns at 1-month post-transplantation.

• Complex periportal halo at 1 month was significantly associated with type B strictures.

• Progressive clinical outcomes were more frequently observed in type B strictures.

Available only for authorised users

Egawa H, Teramukai S, Haga H et al (2014) Impact of rituximab desensitization on blood-type-incompatible adult living donor liver transplantation: a Japanese multicenter study. Am J Transplant 14:102–114CrossRefPubMed

Song GW, Lee SG, Hwang S et al (2014) Biliary stricture is the only concern in ABO-incompatible adult living donor liver transplantation in the rituximab era. J Hepatol 61:575–582CrossRefPubMed

Tanabe M, Kawachi S, Obara H et al (2010) Current progress in ABO-incompatible liver transplantation. Eur J Clin Invest 40:943–949CrossRefPubMed

Ikegami T, Yoshizumi T, Soejima Y, Uchiyama H, Shirabe K, Maehara Y (2016) Feasible usage of ABO incompatible grafts in living donor liver transplantation. Hepatobiliary Surg Nutr 5:91–97PubMedPubMedCentral

Sanchez-Urdazpal L, Batts KP, Gores GJ et al (1993) Increased bile duct complications in liver transplantation across the ABO barrier. Ann Surg 218:152–158CrossRefPubMedPubMedCentral

Demetris AJ, Jaffe R, Tzakis A et al (1988) Antibody-mediated rejection of human orthotopic liver allografts. A study of liver transplantation across ABO blood group barriers. Am J Pathol 132:489–502PubMedPubMedCentral

Minamiguchi S, Sakurai T, Fujita S et al (1999) Living related liver transplantation: histopathologic analysis of graft dysfunction in 304 patients. Hum Pathol 30:1479–1487CrossRefPubMed

Gore RM, Levine MS (2014) Textbook of gastrointestinal radiology. Elsevier Health Sciences

Lawson TL, Thorsen MK, Erickson SJ, Perret RS, Quiroz FA, Foley WD (1993) Periportal halo: a CT sign of liver disease. Abdom Imaging 18:42–46CrossRefPubMed

10.

Stevens SD, Heiken JP, Brunt E, Hanto DW, Flye MW (1991) Low-attenuation periportal collar in transplanted liver is not reliable CT evidence of acute allograft rejection. AJR Am J Roentgenol 157:1195–1198CrossRefPubMed

11.

Chandrashekhara SH, Sharma R, Arora R (2011) Periportal hypodensity on CT: significance and differential diagnosis of an overlooked sign. Clin Res Hepatol Gastroenterol 35:247–253CrossRefPubMed

12.

Kundel HL, Polansky M (2003) Measurement of observer agreement. Radiology 228:303–308CrossRefPubMed

13.

Bang JB, Kim BW, Kim YB et al (2016) Risk factor for ischemic-type biliary lesion after ABO-incompatible living donor liver transplantation. World J GastRoenterol 22:6925–6935CrossRefPubMedPubMedCentral

14.

Haga H, Egawa H, Shirase T et al (2004) Periportal edema and necrosis as diagnostic histological features of early humoral rejection in ABO-incompatible liver transplantation. Liver Transpl 10:16–27CrossRefPubMed

15.

Tanabe T, Ishida H, Horita S et al (2012) Endothelial chimerism after ABO-incompatible kidney transplantation. Transplantation 93:709–716CrossRefPubMed

16.

Tanabe T, Ishida H, Horita S, Yamaguchi Y, Toma H, Tanabe K (2011) Decrease of blood type antigenicity over the long-term after ABO-incompatible kidney transplantation. Transpl Immunol 25:1–6CrossRefPubMed

17.

Tanaka Y, Haga H, Egawa H et al (2005) Intragraft expression of recipient-type ABO blood group antigens: long-term follow-up and histological features after liver transplantation. Liver Transpl 11:547–554CrossRefPubMed

18.

Ito K, Siegelman ES, Stolpen AH, Mitchell DG (2000) MR imaging of complications after liver transplantation. AJR Am J Roentgenol 175:1145–1149CrossRefPubMed

19.

Shyn PB, Goldberg HI (1992) Abdominal CT following liver transplantation. Gastrointest Radiol 17:231–236CrossRefPubMed

20.

Quiroga S, Sebastia MC, Margarit C, Castells L, Boye R, Alvarez-Castells A (2001) Complications of orthotopic liver transplantation: spectrum of findings with helical CT. Radiographics 21:1085–1102CrossRefPubMed

21.

Jorgensen JE, Waljee AK, Volk ML et al (2011) Is MRCP equivalent to ERCP for diagnosing biliary obstruction in orthotopic liver transplant recipients? A meta-analysis. Gastrointest Endosc 73:955–962CrossRefPubMedPubMedCentral

22.

Valls C, Alba E, Cruz M et al (2005) Biliary complications after liver transplantation: diagnosis with MR cholangiopancreatography. AJR Am J Roentgenol 184:812–820CrossRefPubMed

23.

Laghi A, Pavone P, Catalano C et al (1999) MR cholangiography of late biliary complications after liver transplantation. AJR Am J Roentgenol 172:1541–1546CrossRefPubMed

24.

Pecchi A, De Santis M, Gibertini MC et al (2011) Role of magnetic resonance imaging in the detection of anastomotic biliary strictures after liver transplantation. Transplant Proc 43:1132–1135CrossRefPubMed

25.

Girometti R, Como G, Bazzocchi M, Zuiani C (2014) Post-operative imaging in liver transplantation: state-of-the-art and future perspectives. World J Gastroenterol 20:6180–6200CrossRefPubMedPubMedCentral

Title: Computed tomography findings in ABO-incompatible living donor liver transplantation recipients with biliary strictures
Authors: Sang Hyun Choi
Kyoung Won Kim
So Yeon Kim
Jin Sil Kim
Jae Hyun Kwon
Gi-Won Song
Sung-Gyu Lee
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 6/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-5226-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Computed tomography findings in ABO-incompatible living donor liver transplantation recipients with biliary strictures

Abstract

Objectives

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2018

Use of the Kwak Thyroid Image Reporting and Data System (K-TIRADS) in differential diagnosis of thyroid nodules: systematic review and meta-analysis

Impact of noncardiac findings in patients undergoing CT coronary angiography: a substudy of the Scottish computed tomography of the heart (SCOT-HEART) trial

Benefit of 18F-fluorocholine PET imaging in parathyroid surgery

MR neurography in traumatic, non-obstetric paediatric brachial plexopathy

Prospective study aiming to compare 2D mammography and tomosynthesis + synthesized mammography in terms of cancer detection and recall. From double reading of 2D mammography to single reading of tomosynthesis

Evaluation of age-dependent morphometrics of the meniscofemoral ligaments in reference to the posterior cruciate ligament in routine MRI