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Post-operative assessment in patients after liver transplantation: imaging parameters associated with 1-year graft failure

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To identify post-liver transplant CT findings which predict graft failure within 1 year.

Materials and methods

We evaluated the CT scans of 202 adult liver transplants performed in our institution who underwent CT within 3 months after transplantation. We recorded CT findings of liver perfusion defect (LPD), parenchymal homogeneity, and the diameters and attenuations of the hepatic vessels. Findings were correlated to 1-year graft failure, and interobserver variability was assessed.

Results

Forty-one (20.3%) of the 202 liver grafts failed within 1 year. Graft failure was highly associated with LPD (n = 18/25, or 67%, versus 15/98, or 15%, p < 0.001), parenchymal hypoattenuation (n = 20/41, or 48.8% versus 17/161, or 10.6%, p < 0.001), and smaller diameter of portal veins (right portal vein [RPV], 10.7 ± 2.7 mm versus 14.7 ± 2.2 mm, and left portal vein [LPV], 9.8 ± 3.0 mm versus 12.4 ± 2.2 mm, p < 0.001, respectively). Of these findings, LPD (hazard ratio [HR], 5.43, p < 0.001) and small portal vein diameters (HR, RPV, 3.33, p < 0.001, and LPV, 3.13, p < 0.05) independently predicted graft failure. All the measurements showed fair to moderate interobserver agreement (0.233~0.597).

Conclusion

For patients who have CT scan within the first 3 months of liver transplantation, findings of LPD and small portal vein diameters predict 1-year graft failure.

Key Points

•Failed grafts are highly associated with liver perfusion defect, hypoattenuation, and small portal vein.

•Right portal vein < 11.5 mm and left portal vein < 10.0 mm were associated with poor graft outcome.

•Liver perfusion defect and small portal vein diameter independently predicted graft failure.

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Abbreviations

AUC:

Areas under the curve

CCC:

Concordance correlation coefficient

CI:

Confidence interval

HR:

Hazard ratio

HV:

Hepatic vein

IVC:

Inferior vena cava

LPD:

Liver perfusion defect

LPV:

Left portal vein

MELD:

Model for end-stage liver disease

OLT:

Orthotopic liver transplantation

OR:

Odds ratio

PACS:

Picture archiving and communication system

ROC:

Receiver operating characteristic

RPV:

Right portal vein

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Acknowledgments

We would like to give special thanks to Yu-Ching Chou, associate professor in National Defense Medical Center, for his statistics expert and help.

Funding

This study has received funding by study project of Tri-Service General Hospital (TSGH-C108-055).

Author information

Authors and Affiliations

  1. Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan

    Wei-Chou Chang, Sung-Hua Chiu, Guo-Shu Huang & Hsian-He Hsu

  2. Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA

    Benjamin M. Yeh

  3. Department of Radiology, Palo Alto Medical Foundation, Palo Alto, CA, USA

    Lisa Chu

  4. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    So Yeon Kim

  5. Department of Pathology, University of California San Francisco, San Francisco, CA, USA

    Kwun Wah Wen & Chien-Kuang Cornelia Ding

  6. Department of Radiology, University of Washington, Seattle, WA, USA

    En-Haw Wu

  7. Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    John P. Roberts

Authors
  1. Wei-Chou Chang
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  2. Benjamin M. Yeh
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  3. Lisa Chu
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  4. So Yeon Kim
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  5. Kwun Wah Wen
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  6. Sung-Hua Chiu
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  7. Chien-Kuang Cornelia Ding
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  8. En-Haw Wu
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  9. John P. Roberts
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  10. Guo-Shu Huang
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  11. Hsian-He Hsu
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Corresponding author

Correspondence to Wei-Chou Chang.

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Guarantor

The scientific guarantor of this publication is Associate Professor Dr. Wei-Chou Chang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Associate Professor Yu-Ching Chou is a statistics expert and gave us several advices in the statistics.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained by University of San Francisco (12-10492 and 18-26242).

Methodology

•Retrospective

•Diagnostic or prognostic study

•Performed at one institution

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Chang, WC., M. Yeh, B., Chu, L. et al. Post-operative assessment in patients after liver transplantation: imaging parameters associated with 1-year graft failure. Eur Radiol 31, 764–774 (2021). https://doi.org/10.1007/s00330-020-07124-w

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  • DOI: https://doi.org/10.1007/s00330-020-07124-w

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