CT after Intestinal Transplantation: Spectrum of Posttransplant Findings and Their Temporal Evolution

Abstract Computed tomography (CT) plays a central role in the postoperative evaluation of intestinal transplant recipients; however, interpretation remains challenging because expected postoperative findings frequently overlap with pathological processes. Published literature describing the spectrum and temporal evolution of CT findings after intestinal transplantation remains limited. This study evaluates the spectrum of expected and pathological posttransplant CT findings, with emphasis on their temporal evolution. This retrospective observational study included 30 patients who underwent intestinal transplantation at an Indian quaternary care center between April 2023 and April 2026. A total of 134 postoperative CT examinations were analyzed. CT findings were stratified into early (postoperative day [POD] 1–14), intermediate (POD 15–90), and late (POD > 90) postoperative periods and correlated with operative, endoscopic, histopathological, microbiological, and clinical outcome data. Mesenteric edema was the most common postoperative finding and demonstrated gradual temporal resolution. Bowel wall thickening and hyperenhancement were most frequent in the early postoperative period and declined over time. Progressive mesenteric lymphadenopathy was associated with clinically significant pathology, including infection and rejection, while necrotic lymphadenopathy in one patient represented tuberculosis reactivation. Bowel complications included anastomotic leak, adhesive obstruction, ileus, and fungal perforation. Vascular complications comprised active hemorrhage, pseudoaneurysm formation, and graft occlusion. CT findings of rejection showed substantial overlap with infective enteritis, and biopsy-proven rejection could occur despite a grossly normal CT examination. Posttransplant CT findings range from physiological changes to clinically significant pathological abnormalities, and the significance of individual findings changes across the postoperative period. Interpretation should therefore consider both the nature of the finding and its temporal context, in conjunction with the clinical setting. Recognition of this spectrum and its changing clinical significance across the postoperative period is essential for accurate interpretation and appropriate management of intestinal transplant recipients.