Computed tomography findings in ABO-incompatible living donor liver transplantation recipients with biliary strictures

• Published in: European radiology 2018-06, Vol.28 (6), p.2572-2581
• Main Authors: Choi, Sang Hyun, Kim, Kyoung Won, Kim, So Yeon, Kim, Jin Sil, Kwon, Jae Hyun, Song, Gi-Won, Lee, Sung-Gyu
• Format: Article
• Language: English
• Subjects: ABO Blood-Group System; ABO system; Adult; Aged; Blood Group Incompatibility - complications; Blood groups; Cholestasis - blood; Cholestasis - diagnostic imaging; Cholestasis - etiology; Clinical outcomes; Computed tomography; Constriction, Pathologic - blood; Constriction, Pathologic - etiology; Diagnostic Radiology; Female; Graft Survival - physiology; Hepatobiliary-Pancreas; Humans; Imaging; Internal Medicine; Interventional Radiology; Liver; Liver transplantation; Liver Transplantation - adverse effects; Liver Transplantation - methods; Liver transplants; Living Donors; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Postoperative Complications - blood; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Radiology; Retrospective Studies; Stricture; Tomography, X-Ray Computed - methods; Transplant Recipients; Transplantation; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-017-5226-9

Objectives To evaluate CT findings of biliary strictures in ABO-incompatible living donor liver transplantation (LDLT) recipients, with emphasis on associated 1-month post-transplantation CT findings, and evaluate clinical outcomes. Methods Of 351 ABO-incompatible recipients, we retrospectively evaluated CT scans in 65 recipients with biliary stricture. The biliary strictures on CT scans were classified as type A (perihilar) and type B (diffuse). Precedent CT abnormality patterns and the presence of a periportal halo sign at 1-month post-transplantation were evaluated. For each patient, clinical outcomes were evaluated. Results Of 65 ABO-incompatible recipients with biliary strictures, 36.9% had type B strictures. Compared with biliary strictures at diagnosis, similar CT abnormality patterns were observed for 84.4% in type A and 86.4% in type B strictures at 1-month post-transplantation. Complex periportal halo signs on the 1-month post-transplantation CT were more frequently noted for type B than type A strictures (86.4% vs. 3.1%, P < 0.001). Progressive clinical outcomes were more frequently observed for type B than type A strictures (79.2% vs. 26.8%, P < 0.001), with a significantly shorter graft survival time (46.4 months vs. 90.8 months, P < 0.001). Conclusion CT abnormality patterns and complex periportal halo signs on 1-month post-transplantation CT may be clinically useful for managing biliary strictures in ABO-incompatible LDLT recipients. Key Points • Of ABO-incompatible LDLT recipients, type B biliary stricture incidence was 6.8%. • Of type B strictures, 86.4% exhibited similar CT abnormality patterns at 1-month post-transplantation. • Complex periportal halo at 1 month was significantly associated with type B strictures. • Progressive clinical outcomes were more frequently observed in type B strictures.