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Semin intervent Radiol 2022; 39(05): 537-544
DOI: 10.1055/s-0042-1758113
Trainee Corner

Diagnostic and Interventional Radiology in the Management of Post–Liver Transplant Vascular Complications

Ana Gonzalez
1   University of Illinois College of Medicine, Chicago, Illinois
,
Eric Cooper
1   University of Illinois College of Medicine, Chicago, Illinois
,
Josi Herren
2   Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
,
Andrew J. Lipnik
3   Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
,
Karen L. Xie
2   Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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Orthotopic liver transplantation (OLT) is the definitive therapy for patients with end-stage liver disease or acute liver failure. OLT is the second most common type of solid-organ transplant, accounting for 22.8% (8,906 in total) of all organs transplanted in the United States in 2020.[1] Recipient demographic data on OLT recipients have shown a shift to patients with older age, higher illness severity (i.e., Model for End-Stage Liver Disease [MELD] scores), and higher prevalence of obesity and diabetes.[1] Regardless, the evolution of surgical technique and postoperative care since the inception of OLT over 50 years ago has led to reduced morbidity and mortality despite sicker patients being treated.[1]

Despite these achievements, OLT continues to have a high rate of complications (25–30%) impacting patient long-term morbidity and mortality.[2] Biliary complications, such as bile leaks and biliary strictures, are among the most common with an incidence from 15 to 25%.[3] Postoperative infections, fluid collections, graft rejection, and posttransplant lymphoproliferative disorder are also common post-OLT complications. Vascular complications represent a significant portion of post-OLT complications with an incidence of 7 to 15%.[2] Bleeding, stenosis, and thrombosis can arise at any of the vascular anastomotic sites with the potential to result in graft loss and mortality.[4] Improvements in the diagnosis and management of vascular complications following liver transplantation have contributed significantly to improving patient and graft survival rates.

Although surgery historically has been the first choice for addressing post-OLT complications, the advancement of imaging-guided minimally invasive techniques has drastically changed this approach. Interventional radiologists now play a vital role in liver transplant programs by treating posttransplant complications with endovascular and percutaneous procedures that improve graft and patient survival while avoiding surgical revision and/or retransplantation. This article will give an overview of the imaging features of common vascular complications in post-OLT patients and the role of interventional radiology in their management.



Publication History

Article published online:
20 December 2022

© 2022. Thieme. All rights reserved.

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