Elastography in the evaluation of liver allograft


Elastography is an established technique in the evaluation of chronic liver diseases. While there is a large clinical experience and data available regarding the performance of elastography in native liver, elastography experience with liver grafts is limited and still growing. Both ultrasound-based elastography techniques and MR Elastography (MRE) are useful in the assessment of liver fibrosis in liver transplants. Technical modifications for performing elastography will be required for optimum evaluation of the graft. In general, caution needs to be exercised regarding the use of elastography immediately following transplantation as post-operative changes, perioperative conditions/complications, inflammation, and rejection can cause increased stiffness in the graft. In the follow-up, detection of increased stiffness with elastography is useful for predicting development of fibrosis in the graft. Adjunctive MRI or ultrasound with Doppler also provides comprehensive evaluation of anatomy, vascular anastomosis and patency, biliary tree, and stiffness for fibrosis. In this review, we provide a brief overview of elastography techniques available followed by the literature review of elastography in the evaluation of grafts and illustration with clinical examples.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11


  1. 1.

    Yin M, Venkatesh SK. Ultrasound or MR elastography of liver: which one shall I use? Abdominal radiology (New York). 2018;43(7):1546-51.

  2. 2.

    Venkatesh SK, Ehman RL. Magnetic resonance elastography of liver. Magnetic resonance imaging clinics of North America. 2014;22(3):433-46.

  3. 3.

    Zhang YN, Fowler KJ, Ozturk A, Potu CK, Louie AL, Montes V, et al. Liver fibrosis imaging: A clinical review of ultrasound and magnetic resonance elastography. J Magn Reson Imaging. 2019.

  4. 4.

    Barr RG, Ferraioli G, Palmeri ML, Goodman ZD, Garcia-Tsao G, Rubin J, et al. Elastography Assessment of Liver Fibrosis: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2015;276(3):845-61.

  5. 5.

    Younossi ZM, Stepanova M, Rafiq N, Makhlouf H, Younoszai Z, Agrawal R, et al. Pathologic criteria for nonalcoholic steatohepatitis: interprotocol agreement and ability to predict liver-related mortality. Hepatology (Baltimore, Md). 2011;53(6):1874-82.

  6. 6.

    OPTN. 2019 [Available from:

  7. 7.

    Adebajo CO, Talwalkar JA, Poterucha JJ, Kim WR, Charlton MR. Ultrasound-based transient elastography for the detection of hepatic fibrosis in patients with recurrent hepatitis C virus after liver transplantation: a systematic review and meta-analysis. Liver Transpl. 2012;18(3):323-31.

  8. 8.

    Lee VS, Miller FH, Omary RA, Wang Y, Ganger DR, Wang E, et al. Magnetic resonance elastography and biomarkers to assess fibrosis from recurrent hepatitis C in liver transplant recipients. Transplantation. 2011;92(5):581-6.

  9. 9.

    Singh S, Venkatesh SK, Keaveny A, Adam S, Miller FH, Asbach P, et al. Diagnostic accuracy of magnetic resonance elastography in liver transplant recipients: A pooled analysis. Annals of hepatology. 2016;15(3):363-76.

  10. 10.

    Yoon JH, Lee JM, Suh KS, Lee KW, Yi NJ, Lee KB, et al. Combined Use of MR Fat Quantification and MR Elastography in Living Liver Donors: Can It Reduce the Need for Preoperative Liver Biopsy? Radiology. 2015;276(2):453-64.

  11. 11.

    Piccinino F, Sagnelli E, Pasquale G, Giusti G. Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol. 1986;2(2):165-73.

  12. 12.

    Boyum JH, Atwell TD, Schmit GD, Poterucha JJ, Schleck CD, Harmsen WS, et al. Incidence and Risk Factors for Adverse Events Related to Image-Guided Liver Biopsy. Mayo Clinic proceedings. 2016;91(3):329-35.

  13. 13.

    Huwart L, Sempoux C, Vicaut E, Salameh N, Annet L, Danse E, et al. Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology. 2008;135(1):32-40.

  14. 14.

    Singh S, Venkatesh SK, Wang Z, Miller FH, Motosugi U, Low RN, et al. Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. Clin Gastroenterol Hepatol. 2015;13(3):440-51.e6.

  15. 15.

    Wang QB, Zhu H, Liu HL, Zhang B. Performance of magnetic resonance elastography and diffusion-weighted imaging for the staging of hepatic fibrosis: A meta-analysis. Hepatology (Baltimore, Md). 2012;56(1):239-47.

  16. 16.

    Tapper EB, Parikh ND. Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: observational study. Bmj. 2018;362:k2817.

  17. 17.

    Venkatesh SK, Yin M, Ehman RL. Magnetic resonance elastography of liver: technique, analysis, and clinical applications. Journal of magnetic resonance imaging : JMRI. 2013;37(3):544-55.

  18. 18.

    Loomba R, Cui J, Wolfson T, Haufe W, Hooker J, Szeverenyi N, et al. Novel 3D Magnetic Resonance Elastography for the Noninvasive Diagnosis of Advanced Fibrosis in NAFLD: A Prospective Study. The American journal of gastroenterology. 2016;111(7):986-94.

  19. 19.

    Shi Y, Xia F, Li QJ, Li JH, Yu B, Li Y, et al. Magnetic Resonance Elastography for the Evaluation of Liver Fibrosis in Chronic Hepatitis B and C by Using Both Gradient-Recalled Echo and Spin-Echo Echo Planar Imaging: A Prospective Study. The American journal of gastroenterology. 2016;111(6):823-33.

  20. 20.

    Asbach P, Klatt D, Hamhaber U, Braun J, Somasundaram R, Hamm B, et al. Assessment of liver viscoelasticity using multifrequency MR elastography. Magnetic resonance in medicine. 2008;60(2):373-9.

  21. 21.

    Asbach P, Klatt D, Schlosser B, Biermer M, Muche M, Rieger A, et al. Viscoelasticity-based staging of hepatic fibrosis with multifrequency MR elastography. Radiology. 2010;257(1):80-6.

  22. 22.

    Chen J, Talwalkar JA, Yin M, Glaser KJ, Sanderson SO, Ehman RL. Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using MR elastography. Radiology. 2011;259(3):749-56.

  23. 23.

    Godfrey EM, Patterson AJ, Priest AN, Davies SE, Joubert I, Krishnan AS, et al. A comparison of MR elastography and 31P MR spectroscopy with histological staging of liver fibrosis. European radiology. 2012;22(12):2790-7.

  24. 24.

    Rustogi R, Horowitz J, Harmath C, Wang Y, Chalian H, Ganger DR, et al. Accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis. Journal of magnetic resonance imaging : JMRI. 2012;35(6):1356-64.

  25. 25.

    Yin M, Talwalkar JA, Glaser KJ, Manduca A, Grimm RC, Rossman PJ, et al. Assessment of hepatic fibrosis with magnetic resonance elastography. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2007;5(10):1207-13.e2.

  26. 26.

    Hoodeshenas S, Welle CL, Navin PJ, Dzyubak B, Eaton JE, Ehman RL, et al. Magnetic Resonance Elastography in Primary Sclerosing Cholangitis: Interobserver Agreement for Liver Stiffness Measurement with Manual and Automated Methods. Academic radiology. 2019.

  27. 27.

    Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29(12):1705-13.

  28. 28.

    Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol. 2008;48(5):835-47.

  29. 29.

    Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall Med. 2013;34(2):169-84.

  30. 30.

    Bende F, Mulabecirovic A, Sporea I, Popescu A, Sirli R, Gilja OH, et al. Assessing Liver Stiffness by 2-D Shear Wave Elastography in a Healthy Cohort. Ultrasound in medicine & biology. 2018;44(2):332-41.

  31. 31.

    Bruno C, Minniti S, Bucci A, Pozzi Mucelli R. ARFI: from basic principles to clinical applications in diffuse chronic disease-a review. Insights Imaging. 2016;7(5):735–746. doi:10.1007/s13244-016-0514-5

  32. 32.

    Kennedy P, Wagner M, Castera L, Hong CW, Johnson CL, Sirlin CB, et al. Quantitative Elastography Methods in Liver Disease: Current Evidence and Future Directions. Radiology. 2018;286(3):738-63.

  33. 33.

    Park CC, Nguyen P, Hernandez C, Bettencourt R, Ramirez K, Fortney L, et al. Magnetic Resonance Elastography vs Transient Elastography in Detection of Fibrosis and Noninvasive Measurement of Steatosis in Patients With Biopsy-Proven Nonalcoholic Fatty Liver Disease. Gastroenterology. 2017;152(3):598-607.e2.

  34. 34.

    Cui J, Heba E, Hernandez C, Haufe W, Hooker J, Andre MP, et al. Magnetic resonance elastography is superior to acoustic radiation force impulse for the Diagnosis of fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease: A prospective study. Hepatology (Baltimore, Md). 2016;63(2):453-61.

  35. 35.

    Singh S, Muir AJ, Dieterich DT, Falck-Ytter YT. American Gastroenterological Association Institute Technical Review on the Role of Elastography in Chronic Liver Diseases. Gastroenterology. 2017;152(6):1544-77.

  36. 36.

    Ferraioli G, Wong VW-S, Castera L, Berzigotti A, Sporea I, Dietrich CF, et al. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. Ultrasound in Medicine and Biology. 2018;44(12):2419-40

  37. 37.

    Yamaoka Y, Washida M, Honda K, Tanaka K, Mori K, Shimahara Y, et al. Liver transplantation using a right lobe graft from a living related donor. Transplantation. 1994;57(7):1127-30.

  38. 38.

    Northup PG, Abecassis MM, Englesbe MJ, Emond JC, Lee VD, Stukenborg GJ, et al. Addition of adult-to-adult living donation to liver transplant programs improves survival but at an increased cost. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2009;15(2):148-62.

  39. 39.

    Lai JC, Pichardo EM, Emond JC, Brown RS, Jr. Resource utilization of living donor versus deceased donor liver transplantation is similar at an experienced transplant center. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2009;9(3):586-91.

  40. 40.

    Middleton PF, Duffield M, Lynch SV, Padbury RT, House T, Stanton P, et al. Living donor liver transplantation–adult donor outcomes: a systematic review. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2006;12(1):24-30.

  41. 41.

    Muzaale AD, Dagher NN, Montgomery RA, Taranto SE, McBride MA, Segev DL. Estimates of early death, acute liver failure, and long-term mortality among live liver donors. Gastroenterology. 2012;142(2):273-80.

  42. 42.

    UNOS. How We Match Organs: United Network for Organ Sharing; 2019 [Available from:

  43. 43.

    LaPointe Rudow D, Warburton KM. Selection and Postoperative Care of the Living Donor. The Medical clinics of North America. 2016;100(3):599-611.

  44. 44.

    Gallegos-Orozco JF, Silva AC, Batheja MJ, Chang YH, Hansen KL, Lam-Himlin D, et al. Magnetic resonance elastography can discriminate normal vs. abnormal liver biopsy in candidates for live liver donation. Abdominal imaging. 2015;40(4):795-802.

  45. 45.

    Kim KM, Choi WB, Park SH, Yu E, Lee SG, Lim YS, et al. Diagnosis of hepatic steatosis and fibrosis by transient elastography in asymptomatic healthy individuals: a prospective study of living related potential liver donors. Journal of gastroenterology. 2007;42(5):382-8.

  46. 46.

    Mancia C, Loustaud-Ratti V, Carrier P, Naudet F, Bellissant E, Labrousse F, et al. Controlled Attenuation Parameter and Liver Stiffness Measurements for Steatosis Assessment in the Liver Transplant of Brain Dead Donors. Transplantation. 2015;99(8):1619-24.

  47. 47.

    Zahr Eldeen F, Mabrouk Mourad M, Liossis C, Bramhall SR. Liver retransplant for primary disease recurrence. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 2014;12(3):175-83.

  48. 48.

    Crespo G, Castro-Narro G, Garcia-Juarez I, Benitez C, Ruiz P, Sastre L, et al. Usefulness of liver stiffness measurement during acute cellular rejection in liver transplantation. Liver Transpl. 2016;22(3):298-304.

  49. 49.

    Klatt D, Kamphues C, Hirsch S, Papazoglou S, Braun J, Sack I, editors. MR elastography of liver transplant patients using parallel imaging techniques. Proc Intl Soc Mag Reson Med; 2011.

  50. 50.

    Wang Y, Ganger DR, Levitsky J, Sternick LA, McCarthy RJ, Chen ZE, et al. Assessment of chronic hepatitis and fibrosis: comparison of MR elastography and diffusion-weighted imaging. AJR American journal of roentgenology. 2011;196(3):553-61.

  51. 51.

    El-Meteini M, Sakr M, Eldorry A, Abdelkader NA, Dabbous H, Montasser I, et al. Non-Invasive Assessment of Graft Fibrosis After Living Donor Liver Transplantation: Is There Still a Role for Liver Biopsy? Transplantation proceedings. 2019.

  52. 52.

    Carrion JA, Navasa M, Bosch J, Bruguera M, Gilabert R, Forns X. Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation. Liver Transpl. 2006;12(12):1791-8.

  53. 53.

    Harada N, Soejima Y, Taketomi A, Yoshizumi T, Ikegami T, Yamashita Y, et al. Assessment of graft fibrosis by transient elastography in patients with recurrent hepatitis C after living donor liver transplantation. Transplantation. 2008;85(1):69-74.

  54. 54.

    Rigamonti C, Donato MF, Fraquelli M, Agnelli F, Ronchi G, Casazza G, et al. Transient elastography predicts fibrosis progression in patients with recurrent hepatitis C after liver transplantation. Gut. 2008;57(6):821-7.

  55. 55.

    Beckebaum S, Iacob S, Klein CG, Dechene A, Varghese J, Baba HA, et al. Assessment of allograft fibrosis by transient elastography and noninvasive biomarker scoring systems in liver transplant patients. Transplantation. 2010;89(8):983-93.

  56. 56.

    Kamphues C, Lotz K, Rocken C, Berg T, Eurich D, Pratschke J, et al. Chances and limitations of non-invasive tests in the assessment of liver fibrosis in liver transplant patients. Clin Transplant. 2010;24(5):652-9.

  57. 57.

    Yoon JH, Lee JY, Woo HS, Yu MH, Lee ES, Joo I, et al. Shear wave elastography in the evaluation of rejection or recurrent hepatitis after liver transplantation. Eur Radiol. 2013;23(6):1729-37.

  58. 58.

    Perry MT, Savjani N, Bluth EI, Dornelles A, Therapondos G. Point Shear Wave Elastography in Assessment of Hepatic Fibrosis: Diagnostic Accuracy in Subjects With Native and Transplanted Livers Referred for Percutaneous Biopsy. Ultrasound Q. 2016;32(3):201-7.

  59. 59.

    Korda D, Lenard ZM, Gerlei Z, Jakab Z, Haboub-Sandil A, Wagner L, et al. Shear-wave elastography for the assessment of liver fibrosis in liver transplant recipients treated for hepatitis C virus recurrence. Eur J Gastroenterol Hepatol. 2018;30(1):27-32.

Download references

Author information

Correspondence to S. K. Venkatesh.

Ethics declarations

Conflict of interest

The authors disclose no potential conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Navin, P.J., Olson, M.C., Knudsen, J.M. et al. Elastography in the evaluation of liver allograft. Abdom Radiol (2020).

Download citation


  • Liver grafts
  • Liver transplants
  • Magnetic resonance elastography
  • Shear wave elastography
  • Transient elastography