E4620. Pearls and Pitfalls of Abdominal Solid Organ Transplantation
  1. Amy Wang; Joint Department of Medical Imaging;, University of Toronto; University of Toronto
  2. Ciara O'Brien; Joint Department of Medical Imaging;, University of Toronto; University of Toronto
The kidney, liver, and pancreas are the most commonly performed abdominal organ transplantations worldwide and continue to rise in case volume. As we encounter increasing number of patients who have had solid organ transplantation, it is imperative that the radiologist is familiar with the relevant surgical techniques and postoperative anatomy, as prerequisites for the evaluation of common acute and delayed complications across various imaging modalities. The pertinent learning points will be illustrated by cases from a large transplantation center.

Educational Goals / Teaching Points
Overview of indication, surgical technique, standard anastomoses, and normal postoperative anatomy/findings in liver, kidney, and pancreas transplantation, respectively. Review of common and important organ specific complications and general post transplantation complications on various imaging modalities. This exhibit aims to enable the learner to review posttransplant imaging in a structured manner and consider the key differentials.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
For each type of organ transplantation, there will be a brief discussion of surgical technique with digital illustrations of the relevant anastomoses alongside cases from our center to demonstrate the expected postoperative radiological appearances. There will be discussion of appropriate imaging modalities and the limitations of imaging in the context of graft rejection, which requires biopsy. This exhibit will use cases from our center to highlight the commonest and most important complications on imaging. For liver transplantation, these include vascular (hepatic arterial thrombosis, stenosis and pseudoaneurysm, celiac artery stenosis, portal and systemic venous thrombosis and stenosis); biliary (stricture, bile leak, biliary cast syndrome/ischemia); and graft parenchyma (infarction and infection). For kidney transplantation these include vascular (renal artery thrombosis, stenosis and pseudoaneurysm, renal vein thrombosis); graft (rejection, infection, urinary obstruction); and subcapsular/perinephric collections (hematoma, urinoma, abscess, lymphocele). For pancreas transplantation (in addition to renal transplant complications in simultaneous pancreas-kidney transplant), these include arterial thrombosis and pseudoaneurysm; venous thrombosis and stenosis; transplant pancreatitis; duodenojejunostomy leak and peri-pancreatic collections. Graft malignancy and posttransplant lymphoproliferative disease, as general transplant-related complications, will also be discussed with example cases.

Understanding of surgical technique, standard anastomoses, and awareness of expected postoperative radiological appearances will provide a good foundation for the evaluation of solid organ transplantation-related complications, which can then be reviewed in a systematic manner to ensure timely diagnosis and optimization of patient care.