Small bowel transplantation (SBT) and multi-visceral transplantation (MVT)is being performed with increasing frequency at specialized transplant centers. New immunosuppressants, refined surgical technique and better post-operative care have improved the success of SBT and MVT. Diagnostic and interventional radiology are part of the multi-disciplinary approach in management of this patient population. This study is a review of our relatively large institutional experience with the goal of identifying common imaging findings and interventional radiology procedures performed in these patients both before and after surgery.
Materials & Methods
A retrospective review of seventy patients who underwent SBT and/or MVT at Georgetown University Hosptial between November 2003 and March 2008 was conducted. Multi-modality imaging, including computed tomography, ultrasound, magnetic resonance and angiography, obtained before and after transplantation was reviewed. Laboratory data, clinical notes and interventional radiology procedures in these patients were also reviewed.
Teaching Points
Imaging is paramount in diagnosing post-transplant complications related to immunosuppression including serious infection, graft versus host disease and post-transplant lymphoproliferative disorder (PTLD). Interventional radiology plays an important role in pre- and post-operative management of these patients. In pre-transplant patients, interventional radiologists provide and ensure reliable long-term central venous access. Common interventional radiology procedures in post-operative patients are aimed at treating complex intra-abdominal fluid collections, biliary complications as well as angiographic evaluation and endovascular treatment of complications related to surgical anastomoses. As small bowel and multi-visceral transplantation becomes more widely adopted, interventional radiology management of common complications will be important in the multi-disciplinary approach required to treat this patient population and further improve graft survival. A fundamental understanding of the relevant anatomy and common complications is important.
1Georgetown University Hospital - Department of Radiology, Division of Interventional Radiology, Washington, DC
2Georgetown University Hospital - Department of Radiology, Division of Abdominal Imaging, Washington, DC
3Georgetown University Hospital - Department of Surgery, Georgetown Hospital Institute of Transplantation, Washington, DC
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