TOPLINE:

A severe periportal halo (PPH) on early posttransplant CT was associated with a more than threefold risk for biliary complications and an about sixfold risk for severe arterial or biliary events requiring invasive treatment.

METHODOLOGY:

• Researchers conducted a retrospective analysis of 133 adult liver transplant recipients (median age, 58 years; 73% men) who underwent contrast-enhanced abdominal-pelvic CT within 30 days post-transplantation at the University Hospital of Strasbourg, France, between January 2018 and December 2019.
• The analysis included the assessment of PPH on CT scans by two blinded radiologists, with semiquantitative grading, and evaluation of the interobserver agreement using Cohen's kappa coefficient.
• Outcomes associated with PPH and biliary complications, as well as arterial or biliary events of grade 3 or higher, were evaluated.
• Time-to-event analyses examined overall survival and severe arterial or biliary event-free survival.

TAKEAWAY:

• Overall, severe PPH was observed in 59 patients (44%), with excellent interobserver agreement (kappa coefficient, 0.914) seen between the radiologists.
• Patients with severe PPH had more biliary complications than those with non-severe or absent PPH (36% vs 15%; P = .006); after adjustment for age, Model for End-Stage Liver Disease score, cold-ischaemia time, and CT indication, severe PPH independently predicted these complications (adjusted odds ratio [aOR], 3.51; P = .007).
• In the multivariate analysis, severe PPH remained associated with arterial or biliary events of grade 3 or higher (aOR, 5.82; P = .005).
• Overall survival up to 60 months did not differ by PPH severity (log-rank P = .36), but severe arterial or biliary event-free survival was significantly lower in patients with severe PPH (log-rank P = .036).

IN PRACTICE:

"The recognition of a severe periportal halo on the first post-transplant CT adds a practical, imaging-based tier to risk stratification that can be translated directly into patient management," the authors wrote, suggesting that "because PPH is reproducible, inexpensive to detect and appears well before clinical or biochemical deterioration, it can be used to individualise early follow-up."

SOURCE:

This study was led by Hadrien Lasolle, Radiology Department, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. It was published online on September 17, 2025, in the European Journal of Radiology.

LIMITATIONS:

The retrospective single-centre design, even with a protocolised early CT pathway, may have limited generalisability. Although 60-month overall survival was reported, very late biliary events occurring after 24 months were not evaluated. Second CT examinations within 90 days were only available in approximately 50% of recipients, occurring at variable, indication-driven times, and the study was underpowered to undertake formal subgroup comparisons.

DISCLOSURES:

No funding information was provided for this study. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.