Biliary and Vascular Complications after Liver Transplantation–From Diagnosis to Treatment

Abstract

The last decades have brought impressive advances in liver transplantation. As a result, there was a notable rise in the number of liver transplants globally. Advances in surgical techniques, immunosuppressive therapies and radiologically guided treatments have led to an improvement in the prognosis of these patients. However, the risk of complications remains significant, and the management of liver transplant patients requires multidisciplinary teams. The most frequent and severe complications are biliary and vascular complications. Compared to vascular complications, biliary complications have higher incidence rates but a better prognosis. The early diagnosis and selection of the optimal treatment are crucial to avoid the loss of the graft and even the death of the patient. The development of minimally invasive techniques prevents surgical reinterventions with their associated risks. Liver retransplantation remains the last therapeutic solution for graft dysfunction, one of the main problems, in this case, being the low number of donors.

Early Intra-Abdominal Bacterial Infections after Orthotopic Liver Transplantation: A Narrative Review for Clinicians

“…These masses are commonly associated with hepatic artery thrombosis. If the bile is already colonized by bacteria, bilomas become colonized as well, though they can also develop a secondary infection [ 16 , 17 ]. The diagnosis of bilomas is made with the aid of imaging techniques such as abdominal ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI), as their signs and symptoms are usually nonspecific.…”

Complicaciones vasculares postrasplante hepático, una situación con alta morbimortalidad

“…Entre las complicaciones vasculares, la trombosis de la arteria hepática es la complicación arterial más común y grave del trasplante de hígado, representando alrededor del 50 % de todas las complicaciones arteriales 7 , con una incidencia que varía del 0 % al 12 %. Es la principal causa de disfunción primaria del injerto hepático 7 .…”

“…Las complicaciones vasculares son menos frecuentes, pero con un pronóstico más incierto, con una incidencia que varía entre el 7-15 %, hasta alcanzar cifras del 25-30 % 3,6,7 . Se pueden clasificar en complicaciones vasculares oclusivas, como trombosis y estenosis 4,6 .…”

“…La tomografía computarizada con contraste se puede emplear en los casos que la ecografía no sea concluyente y en aquellos pacientes que requieren evaluación vascular anatómica más detallada, mientras la angiografía se recomienda cuando se sospecha una anomalía de la arteria hepática no confirmada por otro método. La resonancia magnética nuclear es una alternativa importante en pacientes con deterioro de la función renal 7 , con alta sensibilidad en la identificación de complicaciones vasculares, y la colangiopancreatografía por resonancia magnética es el método no invasivo más preciso para la evaluación de las complicaciones biliares 9 . Otro método diagnóstico es la ecografía con contraste (CEUS), que evalúa las anomalías de la perfusión parenquimatosa, el estado vascular e incluso el árbol biliar 11,12 .…”

Current Understanding of Marginal Grafts in Liver Transplantation

“…Their findings indicated that DCD liver grafts did not exhibit an escalated risk of vascular stenosis in comparison to DBD [88]. Moreover, many studies reached the same conclusion [89,90]. Therefore, it remains to be determined if a marginally elevated rate of vascular complications can be expected when employing DCD donors with advanced age.…”