Interventional Management of Liver Transplantation Related Vascular Complications

Introduction We present a case-based review of common vascular complications following liver transplantation. We review the most common interventional procedures to treat these complications and review clinical outcomes related to these therapies.

While vascular complications following liver transplantation are relatively rare (7–10%), they are associated with a high incidence of graft failure and mortality as they compromise the inflow and outflow to the graft. Advances in endovascular interventions have made different therapeutic options possible to improve the success rate of liver transplantation and reduce surgical re-interventions. Vascular complications, such as hepatic artery, inferior vena cava (IVC), hepatic veins, and portal vein thrombosis/occlusion, and portal hypertension are some of the most common vascular complications treated by interventional radiologists with effective results. Most vascular complications can be divided in early (<1 month) or late (>1 month) after surgery, with early complications being associated with high graft loss and mortality requiring surgery.

Content Organization A case-based review of the most common procedures performed for the management of vascular complications following liver transplantation will be presented. Vascular interventions include IVC, hepatic vein, hepatic artery, or portal vein angioplasty or stenting, transjugular liver biopsy, and transjugular intrahepatic portosystemic shunt (TIPS) for recurrent portal hypertension.

Hepatic artery thrombosis accounts for over 50% of arterial complications, and it is associated with biliary complications, graft failure, and sepsis. Endovascular intervention provides good prognosis, especially in asymptomatic patients (45% vs 82% in asymptomatic), with re-stenosis of ~25% in 1 year. Similar satisfactory findings are found for venous complications.

Leaning Points Interventional radiologists play a central role in the diagnosis and treatment of many of the most commonly encountered vascular complications following liver transplantation, improving patient care when immediate re-implantation is not feasible.