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

Orthotopic liver transplantation (OLT) is the de fi nitive 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 demo-graphic data on OLTrecipients 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, fl uid collections, graft rejection, and posttransplant lympho-proliferative disorder are also common post-OLT complications. Vascular complications represent a signi fi cant portion of post-OLT complications with an incidence of 7 to 15%. 2 Bleeding, stenosis