Vascular Complications in Liver Transplantation
Summary
Liver transplantation remains the definitive treatment for end-stage liver disease, yet vascular complications continue to threaten graft function and patient survival. The most frequent events include hepatic artery thrombosis and stenosis, portal vein stenosis or thrombosis, hepatic vein outflow obstruction (Budd–Chiari syndrome) and rare pseudoaneurysm formation. These complications may precipitate graft ischaemia, biliary strictures, portal hypertension or acute graft loss. Risk factors span technical challenges at arterial or venous anastomoses, variant vascular anatomy, prolonged warm ischaemia time, paediatric-to-adult size mismatch and recipient hypercoagulability. Early detection relies on routine Doppler ultrasound surveillance with supplementary CT or MR angiography in ambiguous cases. Therapeutic strategies range from percutaneous transluminal angioplasty with or without stenting to surgical revision and targeted embolisation. Recent refinements in imaging thresholds, interventional devices and postoperative monitoring protocols have translated into improved graft survival and reduced morbidity. Globally, these advances underscore the need for standardised surveillance algorithms and multidisciplinary expertise in transplant centres to mitigate vascular risk and optimise long-term outcomes.
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Vascular Complications in Liver Transplantation publication trend
The graph below shows the total number of articles in vascular complications in liver transplantation across all publications each year (not limited to Nature Index journals).
Technical terms
Hepatic artery thrombosis: Occlusion of the hepatic artery by a blood clot, leading to graft ischaemia and biliary complications.
Portal vein stenosis: Narrowing of the portal vein lumen that impairs hepatopetal blood flow and may precipitate portal hypertension.
Budd–Chiari syndrome: Hepatic vein outflow obstruction causing hepatic congestion, ascites and potential graft dysfunction.
Pseudoaneurysm: A contained arterial wall injury forming a blood-filled sac, which may rupture and cause life-threatening haemorrhage.
Doppler ultrasound: Non-invasive sonographic technique that assesses blood flow velocity and vessel patency in transplanted organs.
References
- Doppler-ultrasound reference values after pediatric liver transplantation: a consecutive cohort study. European Radiology (2023).
- Role of imaging in the evaluation of vascular complications after liver transplantation. Insights into Imaging (2019).
- Portal vein obstruction after pediatric liver transplantation: A systematic review of current treatment strategies. Transplantation Reviews (2021).
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