imaging in liver transplant
TRANSCRIPT
![Page 1: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/1.jpg)
Update onImaging in Liver Transplantation
Dr.Manoj.K.S.MD DNB RD
KIMS
![Page 2: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/2.jpg)
Introduction
• Liver transplantation, first introduced 40 years back, is the recognized treatment of choice for patients suffering from end-stage liver disease, including documented fulminant hepatic failure, decompensatedcirrhosis, or hepatocellular carcinoma within defined criteria.
• Approximately 800-1000 liver transplant surgeries are performed in India annually
• The number of liver transplantations performed in the United States each year exceeds 6000; however, there are more than 15,000 patients on the waiting list.
• UNOS National Data Report. http://www.unos.org 2011
![Page 3: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/3.jpg)
History
• The first human liver transplants were performed in 1963 by a surgical team led by Dr. Thomas Starzl of Denver,at University of Colorado Medical School.
• Dr.Christian Barnard performed the first Heart transplant on December 3, 1967 in Cape Town, South Africa.
• https://www.kidney.org/transplantation/transaction/Milestones-Organ-Transplantation
![Page 4: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/4.jpg)
INDICATIONS
• Complications of cirrhosis
• Fulminant hepatic failure
• Encephalopathy
• Ascites
• Hepatocellular carcinoma
• Refractory variceal hemorrhage
• Chronic gastrointestinal blood loss due to portal hypertensive gastropathy
![Page 5: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/5.jpg)
INDICATIONS• Hepatitis
• Autoimmune hepatitis
• Chronic hepatitis B
• Chronic hepatitis C
• Chronic cholestatic diseases
• Primary biliary cirrhosis
• Primary sclerosing cholangitis
• Metabolic liver diseases
• Hemochromatosis
• Wilson disease
![Page 6: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/6.jpg)
Contraindications
• Absolute contraindications• Active extrahepatic malignancy• Diffuse hepatic tumor invasion• Thrombosis of the entire portal and SMV system• Active or uncontrolled systemic infection• Active substance or alcohol abuse• Severe cardiopulmonary disease or other comorbid conditions• Lack of social support• Noncompliance• Relative contraindications• Age Cholangiocarcinoma Portal vein thrombosis Chronic
or refractory infection HIV infection Previous malignancyActive psychiatric disorder Poor social support
![Page 7: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/7.jpg)
Three main types of liver transplantation: cadaveric (DDLT), LDLT, and split-liver grafting
• The Model for End-Stage Liver Disease (MELD) is a scoring system used to assess the severity of CLD
• 3-month mortality rate among those with a MELD score of 40 is 100%. For patients with a score of 30–39, mortality within 3 months is 83%; for 20–29, 76%; for 0–19, 27%; and for patients with a score of less than 10, 4%.
![Page 8: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/8.jpg)
The imaging requirements for a Liver Transplantation Unit can be considered under these broad Categories .
• 1.DONOR EVALUATION
• 2.RECIPIENT EVALUATION
• 3.INTRA OPERATIVE IMAGING
• 4. POST TRANSPLANT IMAGING
• 5. FOLLOW UP
![Page 9: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/9.jpg)
DDLT -Donor evaluation
• Pre-operative USG /Doppler
• Intra operative biopsy
![Page 10: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/10.jpg)
DONOR EVALUATION
• CHEST X-RAY
• ULTRASOUND ABDOMEN
• PORTAL/HEPATIC VEIN DOPPLER
![Page 11: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/11.jpg)
Recipient EvaluationRole of Imaging
• Candidate selection
• Search for intra and extrahepatic malignancy
• Surgical planning
– HCC Staging
– Assessment of vessel patency: angioinvasion
– Quantification of diseased liver volume
– Vascular anatomy
– Identification of cirrhosis and sequelae of PHTT
![Page 12: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/12.jpg)
RECIPIENT EVALUATION
• TRIPHASIC CT LIVER & ABDOMEN/PELVIS
• CT /HRCT CHEST
• USG/DOPPLER LIVER
• MRI LIVER & MRCP
• X-RAY CHEST
![Page 13: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/13.jpg)
RECIPIENT EVALUATION• PET SCAN• RADIONUCLIDE SCAN
• MRI Brain • MR Angiography cerebral arteries• Carotid Doppler• Renal artery Doppler
• LIVER BIOPSY
• Cardiac Imaging –Echo, DSE, Contrast Echo,CAG• CT Pulmonary Angio/Lung Perfusion scan
![Page 14: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/14.jpg)
![Page 15: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/15.jpg)
![Page 16: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/16.jpg)
![Page 17: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/17.jpg)
![Page 18: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/18.jpg)
![Page 19: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/19.jpg)
![Page 20: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/20.jpg)
![Page 21: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/21.jpg)
![Page 22: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/22.jpg)
PET SCAN
![Page 23: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/23.jpg)
Recipient Evaluation
![Page 24: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/24.jpg)
Milan & UCSF Criteria
• Milan criteria :
Defined as 1 tumor ≤5 cm; or ≤3 tumors with each tumor ≤3 cm.
• UCSF criteria
Defined as 1 tumor ≤6.5 cm or ≤3 tumors with the largest tumor diameter ≤4.5 cm and total tumor diameter ≤8 cm
![Page 25: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/25.jpg)
Interventional Radiology
• RFA
• TACE
• TARE
• PTBD
• PVE
• TIPS
• Portal vein thrombectomy
• Hepatic venous pressure gradient (HVPG)
![Page 26: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/26.jpg)
INTRA OPERATIVE IMAGING
• Intraoperative Doppler
• Intraoperative Cholangiography
![Page 27: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/27.jpg)
Intraoperative Cholangiogram
![Page 28: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/28.jpg)
Post Transplant Imaging
• Post- operative Doppler
• PORTABLE X-RAY in ICU
• HIDA Scan for post transplant leak assessment
• TRIPLE PHASE CT LIVER (optional before discharge)
![Page 29: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/29.jpg)
Post- operative USG/DopplerStructure Comment
Liver parenchyma Evaluate parenchymal echogenicity, texture and presence of focal lesions
Perihepatic spaces Evaluate for acites, hemorrhage, fluid collections
Biliary system Evaluate for ductal dilatation and intraluminal filling defects
Vasculature >Evaluate hepatic artery, portal vein, hepatic veins and IVC for patency>Evaluate arterial and venous waveforms and measure arterial resistive indices>Evaluate anastomoses for focal color aliasing and elevated velocities
![Page 30: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/30.jpg)
Post Tx Doppler
![Page 31: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/31.jpg)
Hepatic veins -Normal
a wave (atrial systole)
S wave Ven systole
D wave Ven diastole
![Page 32: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/32.jpg)
Post Tx Doppler
![Page 33: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/33.jpg)
Post Transplant Doppler –Artery
In a post-transplant patient, the normal hepatic arterial RI ranges from 0.55 to 0.80
![Page 34: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/34.jpg)
Post Tx Doppler
![Page 35: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/35.jpg)
![Page 36: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/36.jpg)
![Page 37: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/37.jpg)
DONOR EVALUATION
• LIVER STEATOSIS ASSESSMENT
• CT ANGIO LIVER
• CT VOLUMETRY
![Page 38: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/38.jpg)
DONOR EVALUATION
• MRCP
• MRI Liver
• LIVER FIBROSIS assessment with Ultrasound or MR elastography
![Page 39: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/39.jpg)
DONOR EVALUATION
• Mammography
• USG pelvis
• USG Thyroid
• Doppler lower limb arteries/veins
![Page 40: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/40.jpg)
CT Imaging
![Page 41: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/41.jpg)
MR Imaging
![Page 42: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/42.jpg)
LIVER FAT ASSESSMENT
• Liver Attenuation Index (LAI).
• The LAI is the difference between mean hepatic attenuation and mean splenic attenuation (i.e. average density of liver − average density of spleen on non-contrast scan).
• Liver attenuation is calculated by placing the circular region of interest (ROI) of at least 1 cm² area at multiple places in the liver, covering all the hepatic segments
![Page 43: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/43.jpg)
Liver Attenuation Index
• Average attenuation of liver parenchyma on non-contrast CT images varies between 50 and 65 HU and is generally 8-10 HU greater than that of spleen.
• Limanond et al. found in their study that LAI > 5 HU correctly predicted the absence of significant macrovesicular steatosis.
• LAI values of -10 to 5 HU were suggestive of mild to moderate steatosis (6-30%), while LAI values of less than -10 HU were suggestive of moderate to severe hepatic steatosis (i.e. ≥30% fat) with a specificity of 100%.
• Limanond P, Raman SS, Lassman C, Sayre J, Ghobrial RM, Busuttil RW, et al. Macrovesicular hepatic steatosis in living related liver donors: Correlation between CT and histologic findings. Radiology 2004;230:276-80
![Page 44: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/44.jpg)
MR Fat Quantification
• In Phase-Opposed phase
• 3 Point Dixon
• MR Spectroscopy –SVS with PRESS
![Page 45: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/45.jpg)
![Page 46: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/46.jpg)
![Page 47: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/47.jpg)
![Page 48: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/48.jpg)
LDLT
• The most common LDLT technique in adults is right hemihepatectomy, whereby segments V-VIII are harvested, leaving the middle hepatic vein (MHV) with the donor. Right hemi-liver along with its artery, portal vein, bile duct, and the draining hepatic veins is implanted into the recipient.
![Page 49: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/49.jpg)
LDLT
• In pediatric liver transplants, left lateral sectionectomy is the standard method, whereby segments II and III are harvested
• In certain situations of adult LDLT, where either the remnant liver volume in donor is inadequate or there is complex portal venous or biliaryanatomy, a right posterior sectionectomy can also be performed by harvesting only segments VI and VII with their posterior sectional hepatic artery, portal vein, bile duct, and right hepatic vein (RHV)
![Page 50: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/50.jpg)
Arterial reconstruction
•
The conventional hepatic arterial “fish-mouth” anastomosis is an end-to-end anastomosis reconstructed between the donor and recipient arterial anastomoticsites, usually between the splenic artery and common hepatic artery
For cadaveric donors, the donor hepatic artery is harvested at the level of the celiac axis with a patch of the aorta. The aortic patch is then anastomosed to the recipient hepatic artery near the gastroduodenal artery take-off. For living donors, the arterial anastomosis is to the right, left or proper hepatic artery
![Page 51: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/51.jpg)
PV/IVC/BILIARY
• A portal vein anastomosis is usually an end-to-end anastomosis between the two portal veins.
• The piggyback technique is the standard technique IVC .An end-to-side anastomosis is made between the donor IVC and the common stump of recipient hepatic vein
• Biliary anastomosis is an end-to-end anastomosis between the donor common bile duct and the recipient common hepatic duct after a cholecystectomy
![Page 52: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/52.jpg)
SEGMENTAL ANATOMY
![Page 53: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/53.jpg)
ARTERIAL ANATOMY
![Page 54: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/54.jpg)
PORTAL VEIN -3D MIP
![Page 55: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/55.jpg)
Hepatic Veins -3D MIP
![Page 56: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/56.jpg)
Total volume
![Page 57: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/57.jpg)
RIGHT & LEFT LOBE VOLUME
![Page 58: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/58.jpg)
Partial volumes
![Page 59: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/59.jpg)
![Page 60: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/60.jpg)
![Page 61: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/61.jpg)
![Page 62: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/62.jpg)
![Page 63: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/63.jpg)
![Page 64: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/64.jpg)
![Page 65: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/65.jpg)
![Page 66: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/66.jpg)
![Page 67: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/67.jpg)
![Page 68: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/68.jpg)
![Page 69: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/69.jpg)
![Page 70: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/70.jpg)
![Page 71: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/71.jpg)
![Page 72: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/72.jpg)
![Page 73: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/73.jpg)
![Page 74: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/74.jpg)
![Page 75: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/75.jpg)
![Page 76: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/76.jpg)
![Page 77: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/77.jpg)
![Page 78: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/78.jpg)
![Page 79: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/79.jpg)
![Page 80: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/80.jpg)
![Page 81: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/81.jpg)
![Page 82: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/82.jpg)
![Page 83: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/83.jpg)
![Page 84: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/84.jpg)
![Page 85: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/85.jpg)
![Page 86: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/86.jpg)
![Page 87: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/87.jpg)
![Page 88: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/88.jpg)
![Page 89: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/89.jpg)
![Page 90: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/90.jpg)
![Page 91: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/91.jpg)
![Page 92: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/92.jpg)
![Page 93: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/93.jpg)
![Page 94: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/94.jpg)
![Page 95: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/95.jpg)
![Page 96: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/96.jpg)
![Page 97: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/97.jpg)
![Page 98: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/98.jpg)
![Page 99: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/99.jpg)
DONOR MRCP
![Page 100: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/100.jpg)
DONOR MRCP
![Page 101: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/101.jpg)
DONOR MRCP
![Page 102: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/102.jpg)
DONOR MRCP
![Page 103: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/103.jpg)
DONOR MRCP
![Page 104: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/104.jpg)
DONOR MRCP
![Page 105: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/105.jpg)
DONOR MRCP
![Page 106: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/106.jpg)
DONOR MRCP
![Page 107: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/107.jpg)
DONOR MRCP
![Page 108: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/108.jpg)
DONOR MRCP
![Page 109: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/109.jpg)
DONOR MRCP
![Page 110: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/110.jpg)
DONOR MRCP
![Page 111: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/111.jpg)
DONOR MRCP
![Page 112: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/112.jpg)
DONOR MRCP
![Page 113: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/113.jpg)
DONOR MRCP
![Page 114: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/114.jpg)
DONOR MRCP
![Page 115: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/115.jpg)
DONOR MRCP
![Page 116: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/116.jpg)
DONOR MRCP
![Page 117: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/117.jpg)
DONOR MRCP
![Page 118: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/118.jpg)
DONOR MRCP
![Page 119: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/119.jpg)
FOLLOW UP /COMPLICATIONS
• DOPPLER & ULTRASOUND SCAN
• MRI & MRCP
• CT ABDOMEN /CHEST
• CT ANGIOGRAPHY
• MR ANGIOGRAPHY
• DSA
• SCINTIGRAPHY -HIDA
• ERCP
• LIVER BIOPSY
• CONTRAST ULTRASOUND
• INTERVENTIONAL RADIOLOGY
• PET-CT/ BONE SCAN
![Page 120: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/120.jpg)
IR in LT Complications
• Vascular
• Biliary
• General
• Vascular – Hepatic Artery Stenosis/Thrombosis (HAS/HAT), Portal/Hepatic vein,IVC stenosisi
• Biliary leak, strictures
• Drainage of collections, Pleural effusion etc
![Page 121: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/121.jpg)
Combined Liver-Kidney Transplantation
![Page 122: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/122.jpg)
First Pediatric LT at KIMS
Second Pediatric CLKT at KIMS
![Page 123: Imaging in Liver Transplant](https://reader034.vdocument.in/reader034/viewer/2022052117/58eca6f21a28ab43368b467f/html5/thumbnails/123.jpg)
Special Thanks to
• Dr. B.Venugopal• Dr.Madhavan Unni• Dr.Shabeer Ali• Dr.L.Jayasree• Dr.R C Sreekumar• Dr.Manoj Pillai• Dr.Suresh Babu• Dr.Manish Yadav• Dr.Malini• Dr.Shiraz• Mr Judson• Mr Siraj• Liver Transplant Team KIMS • IMA Trivandrum
THANKS TOTCCI
IMA,APS ,SCOGDEPT OF
RADIOLOGY, HPB<,KIMS