Vascular complications following liver transplantation: A literature review of advances in 2015

Table 1 Vascular complications following orthotopic liver transplantation

Type	Delay (incidence)	Clinical presentation	Diagnosis	Treatment
Arterial complications
HAT incidence: 3.5%	Early HAT (2.9%)	Abnormal transaminase	DUS	Emergent revascularization
		Fever	ce-MDCT	by endovascular intervention
		Biliary complications	Angiography	or surgical revascularization
		Graft failure		or rLT
		Coagulopathy
	Late HAT (2.2%)	Asymptomatic
		Fever
		Abnormal transaminase
		Bile leak
		Hepatic abscess
		Cholangitis
HAS incidence: 2%-13%	Early HAS	Graft failure	DUS	Endovascular intervention
		Biliary complications	ce-MDCT	or surgical revascularization
			Angiography
	Late HAS	Asymptomatic	DUS	Endovascular intervention
		Fever	ce-MDCT	or surgical revascularization
		Abnormal liver function	Angiography
HAP incidence: 2.5%		Asymptomatic	DUS	Endovascular intervention
		Abdominal pain	ce-MDCT	or surgical resection and revascularization
		Fever	Angiography
HAR incidence: 0.64%		Gastrointestinal bleeding	None in emergency	Emergent surgical hemostasis
		Massive bleeding through abdominal drains		and surgical repair
		Hemorrhagic shock
Portal vein complications
PVT incidence: < 3%	Early	Abnormal transaminase	DUS	rLT
		Graf dysfunction	ce-MDCT	or surgical repair
		Multi-organe failure	(portal phase)	or endovascular interventions
		Variceal bleeding	Portography
	Late	Ascite	DUS	Curative anticoagulant therapy
		Portal vein hypertension	ce-MDCT
		Splenomegaly	(portal phase)
		Variceal bleeding	Portography
PVS incidence: 2%-3%	Early	Asymptomatic	DUS	Endovascular interventions
		Portal vein hypertension	ce-MDCT
		Abnormal transaminase	(portal phase)
			Portography
	Late	Asymptomatic	DUS	Anticoagulant therapy
		Ascite	ce-MDCT	and/or
		Abnormal liver test function	(portal phase)	Endovascular interventions
			Portography
Caval anastomosis complications
Caval resection and end-to-end	Early	Acute Budd-Chiari syndrome	DUS	Endovascular intervention
cavo-caval anastomosis		Graf failure	ce-MDCT	or surgical repair
		Intestinal congestion	Cavography	or rLT
		Renal dysfunction
		Lower limb edema
	Late	Moderate Budd-Chiari syndrome	DUS	Endovascular intervention
		Ascite	ce-MDCT
			Cavography
Piggy-back	Early	Acute Budd Chiari	DUS	Surgical repair
		Graf failure	ce-MDCT	or rLT
		Intestinal congestion	Cavography
		Renal dysfunction
		Lower extremity edema
	Late	Moderate Budd-Chiari	DUS	Endovascular intervention
		Ascite	ce-MDCT
		Lower extremity edema	Cavography
		Renal dysfunction
		Abdormal liver test function

Clinical characteristics of arterial and caval complications. rLT: Re-liver transplantation; DUS: Doppler ultrasound; HAT: Hepatic artery thrombosis; HAS: Hepatic artery stenosis; HAP: Hepatic artery pseudoaneurysm; HAR: Hepatic artery rupture; PVT: Portal vein thombosis; PVS: Portal vein stenosis; MDCT: Multi-detector computed tomography.