CT of acute rejection after liver transplantation: a matched case–control study

  • Jong Keon Jang
  • Kyoung Won KimEmail author
  • Sang Hyun Choi
  • So Yeong Jeong
  • Ji Hun Kim
  • Eun Sil Yu
  • Jae Hyun Kwon
  • Gi Won Song
  • Sung Gyu Lee



This study was conducted in order to investigate computed tomography (CT) findings associated with acute cellular rejection (ACR) following liver transplantation (LT) and their relevance to clinical outcomes.

Materials and methods

We analyzed 120 patients with newly diagnosed ACR following LT for various liver diseases and 119 controls matched for age, sex, type of liver graft, and date of CT exam following LT. Two radiologists analyzed the images for morphological characteristics of the graft, morphological change in the major draining vein, graft enhancement in the portal venous phase, graft attenuation on noncontrast CT, and periportal halo. Univariate analysis was used to determine the association between radiological findings and ACR. Clinical outcomes, including treatment response and graft survival, were compared between patients with and without associated radiological findings.


Morphological characteristics of the graft (i.e., globular swelling), morphological change in the major draining vein (i.e., nonanastomotic luminal narrowing), and heterogeneous enhancement were significantly associated with ACR (all p < 0.001). On univariate analysis, the severity of morphological characteristics of the grafts (mild/severe: odds ratio [OR], 19.98/32.24) and morphological change in the major draining vein (without/with prestenotic dilatation: OR, 4.17/22.5) were significantly associated with the increased possibility of an ACR diagnosis. Clinical outcomes for treatment response and graft survival were not significantly different between patients with and without associated radiological findings.


Globular swelling, nonanastomotic stenosis with or without prestenotic dilatation of the major draining vein, and heterogeneous enhancement of the graft on portal venous-phase CT were significantly associated with ACR.

Key Points

Globular swelling of the graft, nonanastomotic narrowing in the major vein, and heterogeneous graft enhancement on CT were significantly associated with acute cellular rejection (ACR).

• Associated CT findings were highly specific but not sensitive for differentiating ACRs from matched controls.


Graft rejection Liver transplantation Computed tomography Delayed graft function 



Acute cellular rejection


Calcineurin inhibitors


Computed tomography


Deceased donor liver transplantation


Hepatic vein


Living donor liver transplantation


Liver transplantation


Rejection activity index



This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT, and Future Planning (No. 2017R1E1A1A03070961).

Compliance with ethical standards


The scientific guarantor of this publication is Kyoung Won Kim.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• case–control study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  2. 2.Department of Diagnostic Pathology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  3. 3.Division of Liver Transplantation and Hepatobiliary Surgery, Department of SurgeryUniversity of Ulsan College of MedicineSeoulSouth Korea

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