Spectrum of Imaging Findings After Intestinal, Liver-Intestinal, or Multivisceral Transplantation: Part 2, Posttransplantation Complications
AJR 2004; 183:1285-1291.
Unsinn KM, Koenigsrainer A, Rieger M, Czermak BV, Ellemunter H, Margreiter R, Jaschke WR, Freund MC.
Transplantation of the small bowel, either as isolated intestinal or combined liver-intestinal or as multivisceral transplantation, has emerged as a potential alternative to total parenteral nutrition in patients with irreversible chronic intestinal failure. Compared with other solid organ transplantations, intestinal transplantation is hampered by the presence of a large number of immunocompetent donor lymphocytes in gut-associated lymphoid tissue and mesenteric nodes as well as bacterial contamination, all of which increase the risk for transplant rejection and infection. In the past decade, patient and intestinal graft survival rates have improved consistently thanks to refined surgical techniques, introduction of better immunosuppressive regimens including tacrolimus, and better antimicrobial therapy of opportunistic infections. These advances decreased technical and immunologic failure rates as well as the infection rate. Today transplantation centers report a 1-year patient and graft survival rate of 81% and 63%, respectively . However, these rates compare less favorably with 1-year survival rates associated with solid organs transplantations of the heart, liver, kidney, and pancreas, which have 1-year patient and graft survival rates that approach or exceed 90% .
Knowledge of the transplantation procedure and knowledge of postoperative imaging anatomy of the intestinal graft are basic requirements for radiologists. Graft survival, among other factors, corresponds to early diagnosis and therapy for specific graft-related complications including leakage of enteric anastomosis, abdominal abscess, peritonitis, thrombosis of graft vessels, hematoma, and posttransplantation lymphoproliferative disorder. This pictorial essay uses various imaging techniques to show the imaging spectrum of diseases after isolated intestinal, combined liver-intestinal, or multivisceral transplantation.