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Vascular Complications After Living Related Liver Transplantation: Evaluation with Gadolinium-Enhanced Three-Dimensional MR Angiography

Bong Soo Kim1, Tae Kyoung Kim1, Dong Jin Jung1, Jung Hoon Kim1, In Young Bae1, Kyu-Bo Sung1, Pyo Nyun Kim1, Hyun Kwon Ha1, Sung Gyu Lee2 and Moon-Gyu Lee1

1 Department of Diagnostic Radiology, University of Ulsan, Asan Medical Center, 388-1 Poongnap-dong, Songpa-ku, Seoul, 138-736, Korea.
2 Department of Surgery, University of Ulsan, Asan Medical Center, Songpa-ku, Seoul, 138-736, Korea.



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  		Fig. 1. —Drawing shows living related liver transplant with right lobe graft. Three sites of vascular anastomosis are hepatic artery, portal vein, and hepatic vein.

 


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  		Fig. 2A. —39-year-old man who underwent living related liver transplantation with right lobe graft. Maximum-intensity-projection (MIP) image from gadolinium-enhanced MR angiography shows normal transplanted hepatic artery (arrow). Observers interpreted hepatic artery at anastomotic site as grade I.

 


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  		Fig. 2B. —39-year-old man who underwent living related liver transplantation with right lobe graft. MIP image from gadolinium-enhanced MR angiography shows patent portal vein (arrow) at anastomotic site. Observers interpreted portal vein as grade I.

 


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  		Fig. 3A. —60-year-old man with hepatic artery stenosis after living related liver transplantation with left lobe graft. Maximum-intensity-projection image from gadolinium-enhanced MR angiography shows diffuse narrowing of hepatic artery (arrows) at anastomotic site. Observers interpreted hepatic artery as grade III.

 


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  		Fig. 3B. —60-year-old man with hepatic artery stenosis after living related liver transplantation with left lobe graft. Conventional hepatic angiogram shows hepatic arterial stenosis (arrows) at anastomotic site.

 


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  		Fig. 4A. —45-year-old man with hepatic arterial stenosis and pseudoaneurysm after living related liver transplantation with right lobe graft. Maximum-intensity-projection image from gadolinium-enhanced MR angiography shows abrupt cutoff of proper hepatic artery (arrow) just beyond its origin. Observers interpreted hepatic artery as grade IV.

 


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  		Fig. 4B. —45-year-old man with hepatic arterial stenosis and pseudoaneurysm after living related liver transplantation with right lobe graft. Conventional angiogram shows severe narrowing of hepatic artery (solid arrow) and pseudoaneurysm (open arrow) at anastomotic site.

 


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  		Fig. 5A. —40-year-old man who underwent living related liver transplantation with right lobe graft. Maximum-intensity-projection image from gadolinium-enhanced MR angiography shows focal signal loss (arrow) of hepatic artery at anastomotic site. Observers interpreted hepatic artery as grade III.

 


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  		Fig. 5B. —40-year-old man who underwent living related liver transplantation with right lobe graft. Conventional angiogram shows normal hepatic artery at anastomotic site. Note multiple surgical clips (arrow) adjacent to anastomosis.

 


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  		Fig. 6A. —41-year-old man with portal vein stenosis after living related liver transplantation with right lobe graft. Maximum-intensity-projection image from gadolinium-enhanced MR angiography shows severe narrowing (solid arrow) of portal vein with poststenotic dilatation. Observers interpreted portal vein as grade IV. Note dilated coronary vein (open arrow) due to portal hypertension.

 


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  		Fig. 6B. —41-year-old man with portal vein stenosis after living related liver transplantation with right lobe graft. Transhepatic portogram shows high-grade stenosis of portal vein and retrograde flow in coronary vein. Pressure gradient between prestenotic and poststenotic regions is 10 mm Hg. After balloon angioplasty and placement of Wallstent (Schneider, Minneapolis, MN, and Buelach, Switzerland), portal vein at anastomotic site is widely patent and pressure gradient across stenosis decreased to 1 mm Hg (not shown).

 


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  		Fig. 7. —Diagram of algorithm for evaluation of vascular complications after living related liver transplantation shows that MR angiography is useful when Doppler sonography and clinical findings are discordant.

 

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