Transplant Liver

Ultrasound protocols for transplant liver

Transplant Liver Day One As imaging in the immediate post transplant period can be extremely difficult, detailed assessment of the liver parenchyma is not essential (though it should be attempted). The aim of the study is to confirm rule out significant narrowing or occlusion of hepatic vascular connections, rule out bile duct obstruction and identify any significant peri-hepatic collections Assess: Hepatic vasculaturE Bile duct calibre Peri-hepatic collections / pleural space Standard documentation: Longitudinal and transverse views to demonstrate any peri-heptic collections Longitudinal view of the porta hepatis, demonstrating the bile duct with measurement of calibre Colour Doppler images / PW Doppler spectral waveforms +/- clip store of: Main, left and right portal veins Main, left and right hepatic artery (if possible measure R.I. and acceleration time) Main, left and right hepatic veins IVC

FOLLOW-UP STUDIES Imaging of transplant livers (even well after transplantation) is often very difficult, assessment of parenchymal detail should be attempted but may be severely limited due to technical restictions. Assessment may be limited to the liver and porto-hepatic vasculature or may be extended to a full scan of the upper abdomen as indicated by the referring clinician or radiologist. Assess: Hepatic size Hepatic echotexture / echogenicty Hepatic contour Intrahepatic biliary tree Hepatic vasculature Bile duct calibre Bile duct lumen Peri-hepatic collections / pleural space Remainder of upper abdomen if indicated Standard documentation: Longitudinal view of lateral segment of the left lobe Longitudinal view of the left lobe and caudate lobe and IVC Longitudinal view of the porta hepatis Longitudinal views of the right lobe and gall bladder Longitudinal view of the mid right hepatic lobe Longitudinal view of the right lobe and right kidney Transverse view of the hepatic veins / IVC Transverse view of the portal vein Bile duct view with intrahepatic measurement. Bile duct view with extrahepatic measurement. Colour Doppler images / PW Doppler spectral waveforms +/- clip store of: Main, left and right portal veins Main, left and right hepatic artery Main, left and right hepatic veins IVC Views of other upper abdominal structures as per protocol (only if indicated) nb: Views obtained may be significantly altered and/or reduced from the above list depending on technical considerations.

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