Abstract

Purpose To describe and review the diagnosis and endovascular treatment of common vascular complications of liver transplant. Material and Methods 1.) Review of the literature regarding vascular complications of liver transplant, with particular attention to those complications commonly diagnosed and treated by the Interventional Radiologist. 2.) Discussion of a case example of one such complication, portal vein stenosis, recently treated by balloon dilatation and stenting at our institution. 3.) Review and discussion of other case examples from the literature or our institutional experience, pertaining to other vascular complications. Results Vascular complications after liver transplant are not infrequently encountered. These include hepatic artery thrombosis and stenosis, as well as stenosis of the portal vein, hepatic veins, and IVC. Portal vein thrombosis can also be seen. With the exception of hepatic artery thrombosis, these are often treated with balloon dilatation and/or stenting with satisfactory results. In the case of hepatic artery thrombosis, selective thrombolytic injection can be employed in the affected branch, although stenting and/or balloon dilatation may still be required for a concomitant hepatic artery stenosis. In addition, combinations of anti-platelet therapy and anticoagulation are often utilized in conjunction with stent placement. As an example of one such complication, we discuss a relatively uncommon case of portal vein stenosis. Incidentally, the stenosis was of such severity that it caused post stenotic aneurysmal dilatation of more proximal portion, which has not been previously reported to our knowledge. Portal venous stenoses are relatively uncommon, being reported in approximately 3% of cases. There are various post treatment medical management related issues to address as well, such as the type and duration of anticoagulation to use and when the patient should return for routine follow-up. Conclusions In conclusion, we review the common vascular complications that can be seen after liver transplant, using a case of portal vein stenosis and associated post stenotic dilatation of the portal vein as an example. Generally speaking, they are relatively infrequent, occurring in as many as 5% of patients. Yet, a working familiarity with these complications and expected subsequent management is useful, particularly at smaller centers or community hospitals where there is no transplant program. These important considerations are discussed and addressed in this concise review of the topic.