Imaging recommendation · Abdomen · Pelvis

Liver transplant — post-operative imaging and complications

Q: What's the alternative imaging for liver transplant — post-operative imaging and complications when hepatic artery thrombosis / stenosis suspected?

CT — CT angiography of the liver (iv contrast).

Q: What's the alternative imaging for liver transplant — post-operative imaging and complications when suspected biloma / collection drainage?

CT — CT or US-guided drainage (iv contrast).

Q: What's the alternative imaging for liver transplant — post-operative imaging and complications when rejection vs vascular complication — biopsy?

US — US-guided liver biopsy (no contrast).

Q: What's the alternative imaging for liver transplant — post-operative imaging and complications when ptld or recurrent hcc?

MRI — MRI liver with hepatobiliary contrast or FDG-PET-CT (iv contrast).

Recommended: Doppler ultrasound of the liver and hepatic vessels is the preferred imaging study for liver transplant — post-operative imaging and complications. Doppler US is first-line: hepatic artery (HA thrombosis is the most feared early complication — patency confirmed by waveform + flow), portal vein, hepatic veins, IVC, biliary anatomy (intra/extrahepatic dilation), peri-graft collections.

Recommended study

Doppler ultrasound of the liver and hepatic vessels

US No contrast Preferred Abdomen · Pelvis Acute inpatientOutpatient Reviewed 2026-05

Doppler US is first-line: hepatic artery (HA thrombosis is the most feared early complication — patency confirmed by waveform + flow), portal vein, hepatic veins, IVC, biliary anatomy (intra/extrahepatic dilation), peri-graft collections. MRI / CT / cholangiography for problems US can't resolve.

If the default doesn't apply

Hepatic artery thrombosis / stenosis suspected

CT CT angiography of the liver IV contrast

Biliary stricture suspected

MRI MRCP No contrast

Suspected biloma / collection drainage

CT CT or US-guided drainage IV contrast

Rejection vs vascular complication — biopsy

US US-guided liver biopsy No contrast

PTLD or recurrent HCC

MRI MRI liver with hepatobiliary contrast or FDG-PET-CT IV contrast

Watch-outs

Hepatic artery thrombosis (HAT)

Early HAT (within weeks) → graft loss. The graft is dependent on HA alone post-transplant (no dual blood supply). Confirm patency with daily US in the early post-op.

Anastomotic biliary stricture

Most common late biliary complication — present with elevated LFTs and intrahepatic ductal dilation on US/MRCP.

Recurrent HCC vs benign post-transplant nodules

MRI with hepatobiliary contrast > CT for differentiating recurrence in the cirrhotic-explant-replaced graft.

Pearls

Normal HA waveform: low-resistance, brisk upstroke, RI 0.5–0.7. Tardus parvus → stenosis.
Routine post-op US: daily for the first week, then per protocol.
Early HA flow loss can be salvaged by interventional thrombolysis if caught quickly — US findings should trigger urgent CT angiography.
Biliary anastomosis: duct-to-duct (most common) vs Roux-en-Y hepaticojejunostomy.