Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA.
Abdom Radiol (NY). 2023 Jan;48(1):166-185. doi: 10.1007/s00261-022-03714-y. Epub 2022 Oct 26.
Liver transplantation is a potentially curative treatment for patients with acute liver failure, end-stage liver disease, and primary hepatic malignancy. Despite tremendous advancements in surgical techniques and immunosuppressive management, there remains a high rate of post-transplant complications, with one of the main complications being biliary complications. In addition to anastomotic leak and stricture, numerous additional biliary complications are encountered, including ischemic cholangiopathy due to the sole arterial supply of the bile ducts, recurrence of primary biliary disease, infections, biliary obstruction from stones, cast, or hemobilia, and less commonly cystic duct remnant mucocele, vanishing duct syndrome, duct discrepancy and kinking, post-transplant lymphoproliferative disorder, retained stent, and ampullary dysfunction. This article presents an overview of biliary anatomy and surgical techniques in liver transplantation, followed by a detailed review of post-transplant biliary complications with their corresponding imaging findings on multiple modalities with emphasis on magnetic resonance imaging and MR cholangiopancreatography.
肝移植是治疗急性肝衰竭、终末期肝病和原发性肝恶性肿瘤患者的一种潜在的根治性治疗方法。尽管在外科技术和免疫抑制管理方面取得了巨大进展，但肝移植后仍存在很高的并发症发生率，其中主要的并发症之一是胆道并发症。除了吻合口漏和狭窄，还会遇到许多其他胆道并发症，包括胆管唯一动脉供应引起的缺血性胆管病、原发性胆道疾病的复发、感染、结石、铸型或血胆引起的胆道阻塞，以及不太常见的胆囊管残端黏液囊肿、消失胆管综合征、胆管差异和扭曲、移植后淋巴增生性疾病、留置支架和壶腹功能障碍。本文首先介绍肝移植中的胆道解剖和外科技术，然后详细回顾肝移植后的胆道并发症及其在多种影像学模式上的相应影像学表现，重点介绍磁共振成像和磁共振胰胆管成像。
