Interventional radiologic procedures in liver transplantation

Postoperative biliary and vascular complications contribute significantly t o morbidity and mortality in liver transplantation. Interventional radiolog ists are an integral part of the multidisciplinary team necessary for optim izing the management of these complications. During a 15-year period, 39 ca daveric and 25 living related liver transplantations were performed at the Chang Gung Memorial hospital, Taiwan. Of 64 liver transplant recipients, 9 (3 adult and 6 pediatric) underwent 13 interventional radiological procedur es for the treatment of biliary sludge-casts (n = 2), bile duct occlusion o r stenosis (n = 2), hepatic veins thrombosis (n = 1), hepatic veins stenosi s (n = 1), portal vein stenosis with splenorenal shunting (n = 1), biloma ( n = 1), and infected fluid collection or ascites (n = 4). Antegrade or retr ograde interventional approach was used to successfully treat all biliary c omplications, and all percutaneous drainage procedures were effective in th e control of intra-abdominal fluid collections. Portal vein stenosis was tr eated by balloon dilatation, and the associated splenorenal shunt was close d by metallic coil embolization via transhepatic catheterization of the por tal vein. Hepatic vein stenosis was effectively treated by balloon dilatati on and expandable metallic stent deployment via transfemoral and jugular ve nous approaches, respectively. Hepatic vein thrombosis was only partially l ysed by transvenous streptokinase administration, and surgical thrombectomy was needed to achieve complete recanalization. The total success rate of t he interventional procedures was 92 % with no procedure-related complicatio ns. The overall survival rate in this series is 89 %, and all patients who underwent living related liver transplantation maintain to date a 100 % sur vival rate. We can conclude that interventional radiological procedures are very useful for managing biliary and vascular complications after liver tr ansplantation. These techniques provide a cure in most situations, thus obv iating the need for further surgical intervention or re-transplantation.