Sonografie der transplantierten Leber

Zusammenfassung

Das Langzeitüberleben von Lebertransplantierten liegt bei 70–75 %. Im frühen Verlauf sind vaskuläre und im späteren Verlauf biliäre Komplikationen wichtige Ursachen der Morbidität. Mithilfe der Sonografie, insbesondere mit Hinzunahme der Kontrastmittelsonografie, ist eine zuverlässige Diagnose möglich. Auf weitere bildgebende Verfahren sollte im Einzelfall nicht verzichtet werden. Die Therapie bleibt dem interventionellen Gastroenterologen bzw. Radiologen oder Chirurgen vorbehalten.

Abstract

The overall long-term survival rate of liver transplant patients is 70–75 %. During the early stages, the complications are vascular in nature, and in the later stages, biliary complications are major causes of morbidity. With the help of sonography, in particular with the addition of contrast enhanced ultrasound, a reliable diagnosis is possible. Despite this, in individual cases, other additional imaging methods should still be employed. The therapy should be used exclusively by interventional gastroentologists, radiologists or surgeons.

Schlüsselwörter

Lebertransplantation - Duplexsonografie - CEUS

Keywords

liver transplantations - Duplex sonography - CEUS

• Literatur

• 1 NIH Consensus Development Conference Statement. Liver Transplantation. June 20–23, 1983. Hepatology 1984; 4: 107-109
• 2 Busuttil RW, Farmer DG, Yersiz H et al. Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single- center experience. Ann Surg 2005; 241: 905-916
• 3 Pfitzmann R, Benscheidt B, Langrehr JM et al. Trends and experiences in liver retransplantation over 15 years. Liver Transpl 2007; 13: 248-257
• 4 Marudanayagam R, Shanmugam V, Sandhu B et al. Liver retransplantation in adults: a single-centre, 25-year experience. HPB 2010; 12: 217-224
• 5 Rennert J, Dornia C, Georgieva M et al. Identification of early complications following liver transplantation using contrast enhanced ultrasound. J Gastrointestin Liver Dis 2012; 21: 407-412
• 6 Zheng R, Mao R, Ren J et al. Contrast-enhanced ultrasound for the evaluation of hepatic artery stenosis after liver transplantation: potential role in changing the clinical algorithm. Liver Transpl 2010; 16: 729-735
• 7 Sidhu PS, Shaw AS, Ellis SM et al. Microbubble ultrasound contrast in the assessment of hepatic artery patency following liver transplantation: role in reducing frequency of hepatic artery arteriography. Eur Radiol 2004; 14: 21-30
• 8 Claudon M, Dietrich CF, Choi BI et al. Aktualisierte Leitlinien und Empfehlungen für die gute klinische Praxis für den kontrastmittelverstärkten Ultraschall (CEUS) der Leber 2012. Ultraschall Med 2013; 34: 11-29
• 9 Ko EY, Kim TK, Kim PN et al. Hepatic vein stenosis after living donor liver transplantation: evaluation with Doppler US. Radiology 229: 806-810
• 10 Legmann P, Costes V, Tudoret L et al. Hepatic artery thrombosis after liver transplantation: diagnosis with spiral CT. Am J Roentgenol 1995; 164: 97-101
• 11 Wozney P, Zajko AB, Bron KM et al. Vascular complications after liver transplantation: a 5-year experience. Am J Roentgenol 1986; 147: 657-663
• 12 Langnas AN, Marujo W, Stratta RJ et al. Vascular complications after orthotopic liver transplantation. Am J Surg 1991; 161: 76-83
• 13 Quiroga J, Colina I, Demetris AJ et al. Cause and timing of first allograft failure in orthotopic liver transplantation: a study of 177 consecutive patients. Hepatology 1991; 14: 1054-1062
• 14 García-Criado A, Gilabert R, Nicolau C et al. Early detection of hepatic artery thrombosis after liver transplantation by Doppler ultrasonography: prognostic implications. J Ultrasound Med 2001; 20: 51-58
• 15 Berstad AE, Brabrand K, Foss A. Clinical utility of microbubble contrast- enhanced ultrasound in the diagnosis of hepatic artery occlusion after liver transplantation. Transpl Int 2009; 22: 954-960
• 16 Lu Q, Zhong XF, Huang ZX et al. Role of contrast-enhanced ultrasound in decision support for diagnosis and treatment of hepatic artery thrombosis after liver transplantation. Eur J Radiol 2012; 81: e338-e343
• 17 Nolten A, Sproat IA. Hepatic artery thrombosis after liver transplantation: temporal accuracy of diagnosis with duplex US and the syndrome of impending thrombosis. Radiology 1996; 198: 553-559
• 18 Dodd GD, Memel DS, Zajko AB et al. Hepatic artery stenosis and thrombosis in transplant recipients: Doppler diagnosis with resistive index and systolic acceleration time. Radiology 1994; 192: 657-661
• 19 Sidhu PS, Ellis SM, Karani JB et al. Hepatic artery stenosis following liver transplantation: significance of the tardus parvus waveform and the role of microbubble contrast media in the detection of a focal stenosis. Clinical Radiol 2002; 57: 789-799
• 20 Choi EK, Lu DS, Park SH et al. Doppler US for suspicion of hepatic arterial ischemia in orthotopically transplanted livers: role of central versus intrahepatic waveform analysis. Radiology 2013; 267: 276-284
• 21 Park YS, Kim KW, Lee SJ et al. Hepatic arterial stenosis assessed with doppler US after liver transplantation: frequent false-positive diagnoses with tardus parvus waveform and value of adding optimal peak systolic velocity cutoff. Radiology 2011; 260: 884-891
• 22 García-Criado A, Gilabert R, Salmerón JM et al. High resistive index on hepatic artery Doppler in the immediate postoperative period: significance, contributing factors and prognostic implications in liver transplant recipients. AJR 2003; 181: 831-838
• 23 Saad W. Nonocclusive hepatic artery hypoperfusion syndrome (splenic steal syndrome) in liver transplant recipients. Semin Interv Radiol 2012; 29: 140-146
• 24 Chen W, Facciuto ME, Rocca JP et al. Doppler ultrasonographic findings on hepatic arterial vasospasm early after liver transplantation. J Ultrasound Med 2006; 25: 631-638
• 25 García-Criado A, Gilabert R, Bianchi L et al. Impact of contrast-enhanced ultrasound in the study of hepatic artery hypoperfusion shortly after liver transplantation: contribution to the diagnosis of artery steal syndrome. Eur Radiol 2015; 25: 196-202
• 26 Uflacker R, Selvy JB, Chavin K et al. Transcatheter splenic artery occlusion for treatment of splenic artery steal syndrome after orthotopic liver transplantation. Cardiovasc Intervent Radiol 2002; 25: 300-306
• 27 Zhu X, Gao Y, Wang S et al. Contrast-enhanced ultrasound diagnosis of splenic artery steal syndrome after orthotopic liver transplantation. Liver Transpl 2012; 18: 966-971
• 28 Settmacher U, Nussler NC, Glanemann M et al. Venous complications after orthotopic liver transplantation. Clin Transplant 2000; 14: 235-241
• 29 Nghiem H, Tran K, Winter TC et al. Imaging of complications in liver transplantation. Radio-Graphics 1996; 16: 825-840
• 30 Letourneau JG, Castaneda-Zuniga WR. The role of radiology in the diagnosis and treatment of biliary complications after liver transplantation. Cardiovasc Intervent Radiol 1990; 13: 278-282
• 31 Everson GT, Kam I. Immediate postoperative care. In: Maddrey WC, Schiff ER, Sorrell MF, Hrsg. Transplantation of the liver. 3. Auflage. Philadelphia: Lippincott Williams & Wilkins; 2001: 131-162
• 32 Zoepf T, Maldonado-Lopez EJ, Hilgard P et al. Diagnosis of biliary strictures after liver transplantation: which is the best tool?. World J Gastroenterol 2005; 11: 2945-2948
• 33 Axelrod DA, Lentine KL, Xiao H et al. National assessment of early biliary complications following liver transplantation: incidence and outcomes. Liver Transplant 2014; 20: 446-456
• 34 Greif F, Bronsther OL, Van Thiel DH et al. The incidence, timing and management of biliary tract complications after liver transplantation. Ann Surg 1994; 219: 40-45
• 35 aplan SB, Zajko AB, Koneru B. Hepatic bilomas due to hepatic artery thrombosis in liver transplant recipients: percutaneous drainage and clinical outcome. Radiology 1990; 174: 1031-1035
• 36 Kok T, Van der Sluis A, Klein JP et al. Ultrasound and cholangiography for the diagnosis of biliary complications after orthotopic liver transplantation: a comparative study. J Clin Ultrasound 1996; 24: 103-115
• 37 Bechstein WO, Blumhardt G, Ringe B et al. Surgical complications in 200 consecutive liver transplants. Transplant Proc 1987; 19: 3830-3831
• 38 Nakamura N, Nishida S, Neff GR et al. Intrahepatic biliary strictures without hepatic artery thrombosis after liver transplantation: an analysis of 1113 liver transplantations at a single center. Transplantation 2005; 79: 427-432
• 39 Guichelaar MM, Benson JT, Malinchoc M et al. Risk factors for and clinical course of non-anastomotic biliary strictures after liver transplantation. Am J Transplant 2003; 3: 885-890
• 40 Ren J, Zheng BW, Wang P et al. Revealing impaired blood supply to the bile ducts on contrast-enhanced ultrasound: a novel diagnosis method to ischemic-type biliary lesions after orthotropic liver transplantation. Ultrasound Med Biol 2013; 39: 753-760
• 41 Ren J, Lu MD, Zheng RQ et al. Evaluation of the microcirculatory disturbance of biliary ischemia after liver transplantation with contrast-enhanced ultrasound: preliminary experience. Liver Transplant 2009; 15: 1703-1708
• 42 Shah JN, Haigh WG, Lee SP et al. Biliary casts after orthotopic liver transplantation: clinical factors, treatment, biochemical analysis. Am J Gastroenterol 2003; 98: 1861-1867
• 43 Spier BJ, Pfau PR, Lorenze KR et al. Risk factors and outcomes in post-liver transplantation bile duct stones. Liver Transpl 2008; 14: 1461-1465
• 44 Sheng R, Ramirez CB, Zajko AB et al. Biliary stones and sludge in liver transplant patients: a 13-year experience. Radiology 1996; 198: 243-247
• 45 Gow PJ, Chapman RW. Liver transplantation for primary sclerosing cholangitis. Liver 2000; 20: 97-103
• 46 Ferris JV, Baron RL, Marsh Jr JW et al. Recurrent hepatocellular carcinoma after liver transplantation: spectrum of CT findings and recurrence patterns. Radiology 1996; 198: 233-238
• 47 Wu L, Rappaport DC, Hanbidge A et al. Lymphoproliferative disorders after liver transplantation: imaging features. Abdom Imaging 2001; 26: 200-206
• 48 Strouse PJ, Platt JF, Francis IR et al. Tumorous intrahepatic lymphoproliferative disorder in transplanted livers. AJR Am J Roentgenol 1996; 167: 1159-1162
• 49 Moody AR, Wilson SR, Grieg PD. Non-Hodgkin lymphoma in the porta hepatis after orthotopic liver transplantation: sonographic findings. Radiology 1992; 182: 867-870