Abstract:

Objective To analyze the CT findings and clinical significance of severe non-neoplastic arterioportal shunts（APS）in the liver graft after liver transplantation. Methods From January 2004 to March2014，two receptors suffered severe liver non-neoplastic APS and were detected by follow-up CT scans in third affiliated hospital. Combined with the clinical features，Doppler ultrasound and clinical outcomes，the CT findings and clinical effects of APS on the grafts were retrospectively analysed. Results The first branches and their distal branches of the portal vein were significantly enhanced in the contrast-enhanced hepatic arterial phase in both of the two patients，and the enhancement was higher than that of the superior mesenteric vein and splenic vein. In bothof the cases，significant transient enhancement of hepatic parenchyma was also detected around APS in hepatic arterial phase. In Case 1，a doppler ultrasound showed the hepatofugal flow in the left portal vein. Chronic rejectionwas confirmed by the liver biopsy. Reduced blood supply of the hilar bile ducts was detected by a contrast-enhancedultrasound. After received anti-inflammatory，anti-rejection and liver protection therapy，APS in the liver wasdisappeared in the followed CT scans. The hepatopetal flow in the left portal vein and recovered biliary blood supply were showed in the followed ultrasound. Case 2 was a patient with iatrogenic APS occurred during the interventionalprocedure of severe hepatic artery stenosis. One years later，APS still existed in the follow-up CT scan，with obvious ischemic cholangitis. Conclusion After liver transplantation，graft rejection may also be a reason for severe APS.And when amounts of hepatic arterial blood flow to the portal vein system，the receptor may suffer not only severeportal hypertension，but also may suffer ischemic bile duct injuries.