Imaging of vascular complications after hepatic transplantation.

Vascular complications after hepatic transplantation can compromise graft and patient survival. Angiography defines the need for revascularization or retransplantation, but the value of noninvasive imaging in this setting is not clear. To assess the relative merit of noninvasive imaging techniques (sonography, scintigraphy, CT, and MR), we retrospectively reviewed 19 major vascular complications that occurred in 15 of 98 hepatic recipients over a 3 1/2-year period. Portal venous thrombosis was seen in seven patients, donor aortic or hepatic arterial thrombosis in seven, and inferior vena caval thrombosis in five. Sonography provided the initial diagnosis of portal venous thrombosis in three, arterial compromise in five, and caval obstruction in four. CT was the first diagnostic examination to identify portal occlusion in two, donor aortic thrombosis in one, and inferior vena caval thrombosis in one. Scintigraphy and MR imaging provided complementary data. Both sonography and CT are useful in the evaluation of vascular complications that occur after hepatic transplantation; however, neither is sufficiently sensitive to obviate angiographic assessment.