From the Research
For suspected ischemic liver transplant graft, Doppler ultrasound is the initial imaging modality of choice, as it provides real-time information about vascular flow in the graft, particularly in the acute postoperative setting, as noted in the study by 1. This approach is supported by the fact that ultrasound is non-invasive, readily available, and can be performed at the bedside, making it ideal for initial assessment. The key complications to look out for include hepatic artery thrombosis, stenosis, and other vascular issues that can lead to graft ischemia. If the ultrasound findings are equivocal or if further evaluation is needed, contrast-enhanced CT or MRI can be used to provide more detailed information about vascular patency and parenchymal perfusion, as suggested by 2. It's crucial to prioritize early detection and intervention, as graft ischemia can rapidly progress to irreversible damage, with hepatic artery thrombosis being a common vascular complication requiring urgent intervention, as highlighted in the study by 3. Some of the signs of ischemia on imaging include heterogeneous enhancement, delayed or absent arterial flow, and parenchymal hypodensity. The transplant team should be notified immediately of any positive findings to facilitate prompt intervention, emphasizing the importance of timely communication and collaboration in managing suspected ischemic liver transplant grafts, as emphasized in the study by 4. In cases where intervention is planned, angiography may be reserved for further evaluation and treatment, as noted in the study by 5. Overall, a multimodality approach to imaging, starting with Doppler ultrasound and potentially followed by CT or MRI, is essential for the effective management of suspected ischemic liver transplant grafts, as supported by the study by 1.