Post-operative imaging in liver transplantation: State-of-the-art and future perspectives

Table 1 Overview of main complications occurring after liver transplantation

Type of complication	Prevalence in adult OLT patients	Risk factors	Time of onset from OLT
Vascular complications	9%
Hepatic artery complications
Hepatic artery thrombosis	3%-10%	RejectionEnd-to-end anastomosisABO blood group incompatibility Prolonged cold ischemia time of the graftPediatric transplant	Weeks to months
Hepatic artery stenosis	2%-10%	RejectionPoor surgical techniqueClamp injury	Within first 3 mo
Pseudoaneurysm	Rare	AngioplastyLiver biopsyFocal infection	Variable
Portal vein complications	1%-13%
Thrombosis	1%-2%	Technical problems during surgeryExcessive vessel lengthDiscrepancy between donor and recipient calibersHypercoagulability stateHistory of previous thrombosis	Variable
Stenosis	1%		Variable
IVC and hepatic vins complications	Rare
Thrombosis and stenosis	< 1%	Size discrepancy between donor and recipient vesselsSuprahepatic caval kinking from liver rotationSurgical techniqueHypercoagulability stateCompression from graft edema or adjacent fluid collectionChronic thrombusNeointimal hyperplasiaRetransplantationPediatric OLTLDLT (hepatic vein stenosis)	Variable
Hemorrhage	Up to 3%	Piggyback anastomosis	Early from OLT
Biliary complications	11%-30%
Bile leak	4%-5%	T-tube displacement or removal (T-tube leak)Technical failure during surgery (anastomotic leak)HAT (nonanastomotic leak)Ischemic-related injury, immunologically-related injury, cytotoxic injury induced by bile salts (nonanastomotic leak in pts. without HAT)	1-3 mo
Biliary obstruction - anastomotic strictures	Up to 17.6%	Roux-en-Y choledochojejunostomyAnastomotic leakageTechnical factors	Within 1 yr
Biliary obstruction - NAS and ITBL	5%-10%	HAT (NAS)Microangiopathic injury (prolonged warm or cold ischemia times) (ITBL)Immunogenic injury (AB0 incompatibility between donor and recipient, chronic ductopenic rejection, primitive sclerosing cholangitis) (ITBL)cytotoxic injury by bile salts (ITBL)	Within 6 mo (NAS)After 6 mo (ITBL)
Stones, casts and sludge	5.70%	Anastomotic and nonanastomotic biliary stricturesPresence of T-tube or stentHepaticojejunostomyIschemiaInfectionsAlteration in bile composition	Within 1 yr (casts and sludge)After 1 yr (stones)
Primary hepatic complications
Acute cellular rejection	Common	ImmunosuppressionTransplantation for cholestatic diseasePreservation injury	Early from OLT
Chronic ductopenic rejection	Up to 17%	Retransplant for chronic rejectionTransplant for cholestatic diseaseCMV infectionLow levels of immunosuppression	6 wk to 6 mo
Other causes of graft dysfunction	-	Variable	Variable
Collections, hematoma, abscess
Biloma	-	Bile leakageHATHAS	Depends on the cause
Hematoma, seroma	-	Surgical technique	Depends on the cause
Abscess	-	CollectionsBacteremia	Depends on the cause
Malignacies
HCC recurrence	Rare	Selection criteria beyond Milan criteria	Years
PTLD	0.0%-2.9%	EBV infectionCMV donor-recipient mismatchCMV disease	Within 1 yr

Data from[3,5-6,12,16,25,30,60,65]. OLT: Orthotopic liver transplantation; IVC: Inferior vena cava; HAT: Hepatic artery thrombosis; NAS Nonastomotic strictures; ITBL: Ischemic-type biliary lesions; EBV: Epstein–Barr virus CMV: Cytomegalovirus.