Diagnosis & Interventional Radiology (IR) Management of Liver Transplant Complications

A liver transplant can be a life-saving procedure for patients with end-stage liver disease. However, like any major surgery, complications may arise during the postoperative period or years later. Early diagnosis and minimally invasive treatment through Interventional Radiology (IR) play a key role in improving graft survival, reducing patient morbidity, and avoiding repeat surgery.

IR provides image-guided, targeted treatments with shorter recovery times, making it an essential part of modern liver transplant care.

 

Common Liver Transplant Complications

1️⃣ Vascular Complications

Vascular complications are among the most serious issues post-transplant.

Hepatic Artery Stenosis / Thrombosis

  • Most common vascular problem

  • Leads to biliary ischemia and graft failure if untreated

Diagnosis:

  • Doppler Ultrasound

  • CT / MR Angiography

  • Digital Subtraction Angiography (DSA)

IR Management:

  • Balloon angioplasty

  • Stent placement

  • Thrombolysis or thrombectomy

Portal Vein Stenosis / Thrombosis

Occurs due to anastomotic narrowing or clot formation.

Diagnosis:

  • Doppler US

  • CT/MR Venography

  • Portography

IR Management:

  • Balloon angioplasty

  • Stent placement

  • Thrombolysis

  • Transjugular Intrahepatic Portosystemic Shunt (TIPS) in selected patients

Hepatic Vein / IVC Stenosis

Often due to surgical anastomosis issues or compression.

Diagnosis:

  • Doppler US

  • CT venography

  • Venography

IR Management:

  • Balloon angioplasty

  • Stenting

2️⃣ Biliary Complications

Very common due to bile duct ischemia post-transplant.

Biliary Strictures (Anastomotic or Non-Anastomotic)

Symptoms:

  • Jaundice

  • Fever

  • Abdominal discomfort

Diagnosis:

  • Ultrasound

  • MRCP

  • ERCP / PTC (Percutaneous Transhepatic Cholangiography)

IR Management:

  • Percutaneous biliary drainage

  • Balloon dilation

  • Internal/external stenting

  • Rendezvous procedures with ERCP support

Bile Leaks

Often detected early after surgery.

IR Treatment:

  • Percutaneous drainage of collections

  • Biliary diversion/stenting

3️⃣ Fluid Collections & Abscesses

Common Types:

  • Bilomas

  • Hematomas

  • Lymphoceles

  • Abscesses

Diagnosis:

  • Ultrasound

  • CT scan

IR Management:

  • Image-guided percutaneous drainage

  • Catheter placement

  • Aspiration

  • Antibiotic instillation if required

4️⃣ Rejection & Graft Dysfunction

Although primarily medical issues, IR helps:

  • Obtain tissue diagnosis via percutaneous liver biopsy

  • Assess vasculature

  • Evaluate biliary tree

5️⃣ TIPS in Liver Transplant Patients

Used for treating:

  • Portal hypertension

  • Variceal bleeding

  • Ascites

Diagnostic Methods Used in IR

  • Doppler Ultrasound

  • CT Angiography / Venography

  • MRCP

  • DSA (Angiography)

  • Portography

  • Percutaneous Cholangiography

  • Image-guided Biopsy

These tools allow early detection, accurate mapping, and treatment planning.

Benefits of IR in Liver Transplant Care

  • Minimally invasive

  • Lower risk than open surgery

  • Organ-preserving

  • Faster recovery

  • Precise diagnosis and treatment

  • Reduced hospital stay

When to Refer to an Interventional Radiologist?

Consider referral for:

  • Abnormal Doppler findings

  • Jaundice post-transplant

  • Suspected strictures or leaks

  • Vascular narrowing or thrombosis

  • Postoperative fluid collections

  • Persistent fever or sepsis

  • Imaging-guided biopsy requirement

Early referral leads to better prognosis and graft survival.

Conclusion

Interventional Radiology has transformed the management of liver transplant complications. From diagnosing vascular or biliary issues to providing minimally invasive treatments such as angioplasty, stenting, drainage, and biopsy—IR plays a crucial role in preserving graft function and preventing re-transplantation.

A multidisciplinary approach with hepatologists, transplant surgeons, and interventional radiologists ensures optimal outcomes and improved patient quality of life.

 

Book an Appointment / Consultation

If you have been advised for aspiration, drainage, or biopsy—our expert interventional radiology team can provide safe, accurate, and minimally invasive treatment options.

📞 Contact / WhatsApp: 0370-7353445 , 0326-4053417 , 0323-0825571

📍 Clinic Location:

Farooq Hospital :

Avenue Mall, Main Ghazi Rd, DHA, Lahore, Punjab 54000, Pakistan
Mian Muree Expressway, Bahria Golf City Rawalpindi.

🕒 Appointment Timings: 24/7