The Application of Interventional Radiology in Living-Donor Liver Transplantation

Abstract

Owing to improvements in surgical techniques and medical care, living-donor liver transplantation has become an established treatment modality in patients with end-stage liver disease. However, various vascular or non-vascular complications may occur during or after transplantation. Herein, we review how interventional radiologic techniques can be used to treat these complications.

Keywords: Biliary complications; Hepatic arterial; Hepatic vein complications; Living donor liver transplantation; Portal vein complications; complications.

Fig. 1. A 66-year-old woman with stenosis in the main PV bifurcation 12 months after dual left lobes living-donor liver transplantation.

A. CT shows stenosis (arrows) in the main PV bifurcation. B. Dual stents are placed in the right- and left-sided PVs via transsplenic access. C. Transsplenic route is embolized with coils followed by glue. PV = portal vein

Fig. 2. A 67-year-old man undergoing PV stent placement during living-donor liver transplantation.

A. A pre-transplant CT shows extensive main PV thrombosis (arrow). B. Venogram via the superior mesenteric vein after PV thrombectomy and end-to-end PV anastomosis shows diffuse stenosis of the main PV with the remaining thrombi (arrows) in the proximal superior mesenteric vein and main PV. C. Post-stenting venogram shows normalized PV with a disappeared coronary varix. PV = portal vein

Fig. 3. A 51-year-old man with main and right PV thrombosis 12 days after deceased-donor liver transplantation and intraoperative PV stent placement.

A. CT shows thrombosis in the stent-placed main PV (arrows) and right PV. B, C. Venogram via left PV shows diffuse partial thrombosis (arrowheads) in the right PV and thrombotic occlusion (arrows) of the stent-placed main PV. D. Completion venogram after mechanical thrombectomy using the Angiojet^® thrombectomy catheter shows restored PV flow. PV = portal vein

Fig. 4. A 58-year-old man undergoing stent placement using a rendezvous technique 3 days after modified right lobe living-donor liver transplantation.

A. Venogram of the right inferior HV following failed cannulation of the right HV shows the right HV via intrahepatic veno-venous connections but with an occluded proximal right HV (arrow). B. The occlusion is passed through the intrahepatic connection using a guidewire from the inferior HV, and the wire is grasped with a snare in the inferior vena cava. C. Post-stenting venogram shows brisk HV outflow. HV = hepatic vein

Fig. 5. A 24-month-old girl with HV thrombosis 9 months after lateral segment living-donor liver transplantation.

A. Venogram shows thrombotic occlusion (arrows) of the left HV. B. HV outflow is restored after thrombolysis and placement of two stents. C. Two-year follow-up venogram shows in-stent restenosis (arrowhead). The patient underwent 12 sessions of repeat balloon angioplasty and/or mechanical atherectomy due to restenosis during a 12-year follow-up. HV = hepatic vein

Fig. 6. A 54-year-old woman with a HA dissection 2 days after living-donor liver transplantation.

A. Arteriogram shows a dissection (arrow) around the HA anastomosis. B. Arteriogram after a coronary stent placement (4 × 25 mm, NIR stent) (arrowheads) shows normalization of the HA. C. CT obtained 7 years after stent placement still shows patent HA flow. HA = hepatic artery

Fig. 7. A 62-year-old man with cholangitis 35 days after living-donor liver transplantation.

A. Percutaneous cholangiogram shows an anastomotic stricture (arrow). B. A retrievable covered stent (arrowheads) is placed across the stricture for 4 months. A 10 Fr biliary drainage catheter is positioned in the common bile duct through the stent to prevent stent migration.

Fig. 8. A 52-year-old man with incidentally detected biliary abnormalities 3 months after dual left lobe living-donor liver transplantation.

A. CT shows bile duct dilation of the right-sided graft (arrow) and an extrahepatic biloma (arrowhead). B. Percutaneous cholangiogram after failed endoscopic cannulation of the dilated bile duct shows an anastomotic stricture (arrow) with bile leaks (arrowhead). C. A drainage catheter is positioned across the stricture and leak for 7 months.