Computed tomography findings in ABO-incompatible living donor liver transplantation recipients with biliary strictures

Objectives To evaluate CT findings of biliary strictures in ABO-incompatible living donor liver transplantation (LDLT) recipients, with emphasis on associated 1-month post-transplantation CT findings, and evaluate clinical outcomes. Methods Of 351 ABO-incompatible recipients, we retrospectively evaluated CT scans in 65 recipients with biliary stricture. The biliary strictures on CT scans were classified as type A (perihilar) and type B (diffuse). Precedent CTabnormality patterns and the presence of a periportal halo sign at 1-month post-transplantation were evaluated. For each patient, clinical outcomes were evaluated. Results Of 65 ABO-incompatible recipients with biliary strictures, 36.9% had type B strictures. Compared with biliary strictures at diagnosis, similar CT abnormality patterns were observed for 84.4% in type A and 86.4% in type B strictures at 1-month post-transplantation. Complex periportal halo signs on the 1-month post-transplantation CT were more frequently noted for type B than type A strictures (86.4% vs. 3.1%, P < 0.001). Progressive clinical outcomes were more frequently observed for type B than type A strictures (79.2% vs. 26.8%, P < 0.001), with a significantly shorter graft survival time (46.4 months vs. 90.8 months, P < 0.001). Conclusion CT abnormality patterns and complex periportal halo signs on 1-month post-transplantation CT may be clinically useful for managing biliary strictures in ABO-incompatible LDLT recipients.