Type:
Educational Exhibit
Keywords:
Ultrasound-Colour Doppler, MR, CT, Diagnostic procedure, Transplantation, Grafts, Abdominal Viscera, Liver, Abdomen
Authors:
C. González-Carrero Sixto1, S. Sánchez Bernal1, J. Crespo del Pozo2, J. Azcona Saenz1, D. HERRÁN DE LA GALA1, F. J. GONZALEZ1, A. Pérez Del Barrio 1, T. Cobo Ruíz1, D. Castanedo Vázquez1; 1Santander/ES, 2Selaya, Cantabria, España/ES
DOI:
10.26044/ecr2020/C-06509
Background
Liver transplant is the treatment of choice for end stage liver disease. Since it was first performed in 1963, morbidity and mortality have significantly been reduced thanks to advances in surgical techniques, immunosuppressive therapy and multidisciplinary team approach. However, this procedure remains complex and vascular complications are one of the main causes of graft failure.
Radiologists play a key role in the diagnose and follow-up of post-transplant complications. Their clinical manifestations are usually non-specific, so imaging is crucial in their prompt detection. Therefore, radiologists must be familiarized with normal findings after a liver transplant to be able to recognize the principal complications. Only in the absence of radiologic findings further clinicopathologic tests should be performed.
SURGICAL TECHNIQUE
In the standard technique, surgeons made three end-to-end anastomoses, between both donor and recipient hepatic artery (HA), portal vein (PV) and donor common hepatic duct and recipient common bile duct. Nowadays, the anastomosis between the graft hepatic veins (HV) and the recipient inferior vena cava (IVC) is made with the piggyback technique, an end-to-side anastomosis between the common stump of the graft HV and one side of the recipient IVC wall. This happens to be the major advance in surgical liver transplantation technique because decreases the risk of hemorrhage and maintains the normal caval flow during the anhepatic stage of surgery, allowing transplantation to be performed without a venous bypass. Also, substituting two anastomoses by only one decreases the overall time of surgery. Cholecystectomy is routinely performed on all implants.
Nevertheless, there are many normal variants in hepatic vascularization. For these cases special surgical techniques can be used. Knowing the surgical technique is essential to perform a correct radiologic evaluation and follow-up of liver graft.
Fig. 1: Handmade picture of the actual orthotopic liver transplant surgical technique. Anastomosis.