The role of multiphase CT in patients with acute postoperative bleeding after liver transplantation

Purpose: The aim of this study was to investigate the role of multiphase computed tomography (CT) in patients with acute postoperative bleeding after liver transplantation(LT). Methods: We retrospectively analyzed multiphase CT images in 270 post-LT bleeding patients between November 2013 and December 2017, with special attention to contrast extravasation (type I, focal or stipple; type II, jet). Patients were classified into conservative management trial and primary therapeutic intervention groups by initial treatment strategy, and then conservative management trial group was subdivided into successful conservative management and conservative management failure groups. On multiphase CT, we evaluated contrast extravasation volume, rate, and patterns (focal or stipple vs. jet). The concordances of the bleeding source determined by multiphase CT to the actual bleeding source were analyzed. Results: Of 270 patients, 134 contrast extravasation sites were identified in 116 (43.0%) patients. Most (94.8%, 146/154) of patients without contrast extravasation was successfully managed by conservative management. The mean volume and rate of contrast extravasation significantly increased in order of successful conservative management, conservative management failure, and primary therapeutic intervention groups (all p < 0.01). In subgroup analysis, jet pattern contrast extravasation was more commonly observed with conservative management failure group (p = 0.01). In addition, the change in pattern of contrast extravasation from type I to II was significantly related to the conservative management failure (OR 10.3; 95% CI 1.8–60.4; p = 0.01). There was substantial agreement in localization of bleeding source between multiphase CT and surgery or angiography (Cohen Kappa = 0.78). Conclusion: Multiphase CT is helpful in the assessment for need of therapeutic intervention and to determine the treatment of choice in recipient with post-LT bleeding.