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Copyright ©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. May 28, 2014; 20(20): 6180-6200
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6180
Table 1 Overview of main complications occurring after liver transplantation
Type of complicationPrevalence in adult OLT patientsRisk factorsTime of onset from OLT
Vascular complications9%
Hepatic artery complications
Hepatic artery thrombosis3%-10%RejectionEnd-to-end anastomosisABO blood group incompatibility Prolonged cold ischemia time of the graftPediatric transplantWeeks to months
Hepatic artery stenosis2%-10%RejectionPoor surgical techniqueClamp injuryWithin first 3 mo
PseudoaneurysmRareAngioplastyLiver biopsyFocal infectionVariable
Portal vein complications1%-13%
Thrombosis1%-2%Technical problems during surgeryExcessive vessel lengthDiscrepancy between donor and recipient calibersHypercoagulability stateHistory of previous thrombosisVariable
IVC and hepatic vins complicationsRare
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
HemorrhageUp to 3%Piggyback anastomosisEarly from OLT
Biliary complications11%-30%
Bile leak4%-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 stricturesUp to 17.6%Roux-en-Y choledochojejunostomyAnastomotic leakageTechnical factorsWithin 1 yr
Biliary obstruction - NAS and ITBL5%-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 sludge5.70%Anastomotic and nonanastomotic biliary stricturesPresence of T-tube or stentHepaticojejunostomyIschemiaInfectionsAlteration in bile compositionWithin 1 yr (casts and sludge)After 1 yr (stones)
Primary hepatic complications
Acute cellular rejectionCommonImmunosuppressionTransplantation for cholestatic diseasePreservation injuryEarly from OLT
Chronic ductopenic rejectionUp to 17%Retransplant for chronic rejectionTransplant for cholestatic diseaseCMV infectionLow levels of immunosuppression6 wk to 6 mo
Other causes of graft dysfunction-VariableVariable
Collections, hematoma, abscess
Biloma-Bile leakageHATHASDepends on the cause
Hematoma, seroma-Surgical techniqueDepends on the cause
Abscess-CollectionsBacteremiaDepends on the cause
HCC recurrenceRareSelection criteria beyond Milan criteriaYears
PTLD0.0%-2.9%EBV infectionCMV donor-recipient mismatchCMV diseaseWithin 1 yr