Interventional Radiology Management of Liver Transplantation-Related Vascular and Nonvascular Complications

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

Background: Nonvascular complications are very common complications after liver transplantation and include liver abscess, biloma, bile leak, and recurrent malignancy (hepatocellular carcinoma). Advances in endovascular interventions have made possible different therapeutic options to improve the success rate of liver transplantation and reduce surgical reinterventions. While vascular complications following liver transplantation are relatively rare, they are associated with a high incidence of graft failure and mortality. Vascular complications such as inferior vena cava (IVC), hepatic artery, hepatic vein, and portal vein stenosis/occlusion and portal hypertension are some of the most common post-surgical vascular complications treated by interventional radiologists with effective results.

Clinical Findings/Procedure Details: A case-based review of the most common procedures performed for the management of nonvascular and 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 for recurrent portal hypertension. Nonvascular complications treatment includes angioplasty and stenting of the biliary duct, image-guided fluid collection aspiration and drain placement as well as catheter directed chemotherapy, and radiotherapy to new or neoplasm recurrence.

Conclusion and/or Teaching Points: Interventional radiologists play a central role in the diagnosis and treatment of many of the most commonly encountered vascular and nonvascular complications following liver transplantation.

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