Persistence of portosystemic collaterals and splenomegaly on CT after orthotopic liver transplantation.

OBJECTIVE. The appearances of portosystemic collaterals and splenomegaly on CT before and after liver transplantation were evaluated. MATERIALS AND METHODS. The records of 54 patients undergoing liver transplantation during a 2.5-year period were reviewed retrospectively. Twenty-five of these patients, in whom both a preoperative abdominal CT scan and a follow-up CT scan at least 1 year after transplantation had been obtained, were clinically well and had had no significant episodes of rejection, severe recurrent hepatitis, or other complication at the time of study. A total of 94 abdominal CT scans in these patients were reviewed to assess changes in portosystemic collaterals and splenic volume. RESULTS. At 6 months after transplantation, portosystemic collaterals at one or more sites were seen in 14 (74%) of the 19 patients scanned at this time in whom collaterals had been seen on CT preoperatively. At 1 year after transplantation, splenic hilar collaterals persisted in 64% of patients, splenocolic ligament collaterals in 50%, retroperitoneal collaterals in 38%, and peripancreatic collaterals in 38% of patients with preoperative varices at these sites who were examined with CT at this interval. Splenic hilar, coronary, and retroperitoneal collaterals were found to persist for up to 4 years after transplantation in the single patient examined at that time. Splenic volume decreased in 94% of patients examined after transplantation, with a mean reduction of 60 +/- 19%. However, the spleen remained significantly enlarged in 56% of patients. CONCLUSION. We conclude that portosystemic collaterals and splenomegaly frequently persist after liver transplantation, but that this finding need not indicate recurrence of hepatic disease or other posttransplantation complications.