Hepatic venous congestion after living donor liver transplantation with right lobe graft: Two-phase CT findings

PURPOSE: To describe and determine clinical importance of two-phase computed tomographic (CT) findings of hepatic venous congestion after living donor liver transplantation (LDLT) with right lobe graft. MATERIALS AND METHODS: Forty-eight patients underwent two-phase (hepatic arterial phase and portal venous phase [PVP]) CT at 1, 2, and 4 weeks after LDLT. Images were evaluated for hepatic attenuation difference in areas of hepatic venous congestion, opacification of hepatic and peripheral portal veins in those areas, and changes in findings at follow-up CT. CT findings were correlated with serum bilirubin level. Fisher exact test and mixed model were applied. Histopathologic specimens were obtained in six patients. RESULTS: Thirty patients (62%) had attenuation difference in segments V and VIII of right lobe transplant at initial CT scanning. Opacification of hepatic or peripheral portal veins was seen in 17 (63%) and 27 (100%) hyperattenuating areas of congestion during PVP and in none and three (19%) of 16 hypoattenuating areas, respectively. At 4-week follow-up CT, attenuation difference decreased in volume in 11 of 16 patients with hypoattenuation during PVP. All 14 patients with hyperattenuation showed no change in volume, but attenuation difference had decreased or disappeared. Histopathologic specimens showed evidence of hepatic venous congestion in all six patients. Hypoattenuation was seen at PVP CT in all three patients with severe hepatic venous congestion at histopathologic examination. Serum bilirubin level was significantly different between patients with hypoattenuation and those with hyperattenuation during PVP (P = .035) and between patients with hypoattenuation and those without attenuation difference (P = .009). CONCLUSION: Areas possibly related to hepatic venous congestion after LDLT have variable attenuation at CT; decreased enhancement during PVP correlates with increased postoperative serum bilirubin level, which indicates severity of hepatic venous congestion.