Clinical Utility of Hepatic-Perfusion Computerized Tomography in Living-Donor Liver Transplantation: A Preliminary Study M. Kantarci a, *, B. Pirimoglu a , G. Ozturk b , B. Aydinli b , H. Ogul a , A. Okur c , Y. Kizrak a , O. Ozyigit a , and M. Celik d a Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey; b Department of General Surgery, School of Medicine, Atatürk University, Erzurum, Turkey; c Department of Radiology, Yozgat, School of Medicine, Bozok University, Bozok, Turkey; and d Department of Anesthesiology and Reanimation, School of Medicine, Atatürk University, Erzurum, Turkey ABSTRACT Background. Vascular complications are a primary diagnostic consideration in liver trans- plant recipients, with an overall incidence of 9%. Cross-sectional imaging techniques provide information regarding vascular structure and luminal patency but can not quantitatively assess hepatocyte damage in the liver graft parenchyma. Perfusion computerized tomography (CT) is a recently developed method that allows for quantitative evaluation of hemodynamic changes in tissue. Our objective was to evaluate the clinical utility of perfusion CT in assessing vascular complications during living-donor liver transplantation (LDLT). Methods. The 33 recipients were divided into 3 groups according to Doppler ultrasono- graphic findings: hepatic arterial complication group, portal venous complication group, and hepatic venous complication group. Blood volume (BV), blood flow (BF), arterial liver perfusion (ALP), portal venous perfusion (PVP), and hepatic perfusion index (HPI) were calculated for the affected vascular territory regions. Results. Compared with normal liver parenchyma, BV, BF, ALP, and HPI were significantly lower in the hepatic arterial complication group. Although PVP and BV were significantly lower, ALP, HPI, and BF were higher in the affected vascular territory region than in normal liver parenchyma for the portal venous complication group. In the hepatic venous complica- tion group, PVP was significantly higher and BF, ALP, and HPI significantly lower in the affected vascular territory regions than in normal liver parenchyma. Conclusions. Perfusion CT imaging is a noninvasive technique that enables the quantitative evaluation of vascular complications in the graft parenchyma after LDLT and permits a quantitative evaluation of the treatment response. L IVING-DONOR LIVER TRANSPLANTATION (LDLT) has become the treatment of choice for patients with end-stage acute or chronic hepatic disease [1e4]. Vascular complications are a primary diagnostic consideration in liver transplant recipients, with an overall incidence of 9% [4,5]. Doppler ultrasonography (US) is the preferred postoperative screening method to evaluate vascular complications because it is readily accessible, noninvasive, and easily performed at the bedside. However, Doppler US can not directly measure the blood inflow in the hepatic parenchyma itself. It can measure the inflow velocity only in large feeding vessels [6]. The method is also operator dependent with well known inherent limitations [7e9]. Cross-sectional imaging methods, such as computerized tomography (CT) and magnetic resonance imaging (MRI) have a greater overall sensitivity and specificity than Doppler US. However, MRI is not feasible in critically ill patients [10,11]. Furthermore, cross-sectional imaging techniques pro- vide information regarding vascular structure and luminal patency but can not quantitatively assess hepatocyte damage in the liver graft parenchyma [9]. Perfusion CT is a recently developed method that allows for quantitative evaluation of hemodynamic changes in *Address correspondence to Mecit Kantarci, MD, PhD, 200 Evler Mah, 14, Sok No 5, Dadaskent, Erzurum, Turkey. E-mail: akkanrad@hotmail.com ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2014.11.038 Transplantation Proceedings, 47, 399e407 (2015) 399